Provider Demographics
NPI:1710604913
Name:AMEN HOMECARE LLC
Entity Type:Organization
Organization Name:AMEN HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTER
Authorized Official - Prefix:
Authorized Official - First Name:MUSSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIEKE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINSTRATER
Authorized Official - Phone:703-282-9551
Mailing Address - Street 1:5285 SHAWNEE RD
Mailing Address - Street 2:SUITE #575 B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312
Mailing Address - Country:US
Mailing Address - Phone:703-282-9551
Mailing Address - Fax:703-879-2425
Practice Address - Street 1:5285 SHAWNEE RD
Practice Address - Street 2:SUITE #575 B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312
Practice Address - Country:US
Practice Address - Phone:703-282-9551
Practice Address - Fax:703-879-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health