Provider Demographics
NPI: | 1770014839 |
---|---|
Name: | MIDDLEBURG HOME CARE |
Entity Type: | Organization |
Organization Name: | MIDDLEBURG HOME CARE |
Other - Org Name: | HI TECH INFUSIONS |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LANE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 540-316-7515 |
Mailing Address - Street 1: | PO BOX 544 |
Mailing Address - Street 2: | |
Mailing Address - City: | MIDDLEBURG |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 20118-0544 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-316-7515 |
Mailing Address - Fax: | 540-277-2518 |
Practice Address - Street 1: | 6487 MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | THE PLAINS |
Practice Address - State: | VA |
Practice Address - Zip Code: | 20198 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-316-7515 |
Practice Address - Fax: | 540-277-2518 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-03-21 |
Last Update Date: | 2021-05-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | R111424 | 163W00000X |
225100000X, 225200000X, 225XP0019X, 332B00000X, 343900000X, 374U00000X, 385H00000X, 385HR2055X, 385HR2060X, 385HR2065X | ||
VA | HCO1668 | 251E00000X, 251F00000X, 253Z00000X |
VA | HCO181621 | 3747P1801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health | Group - Multi-Specialty | |
No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
No | 251F00000X | Agencies | Home Infusion | Group - Multi-Specialty | |
No | 253Z00000X | Agencies | In Home Supportive Care | Group - Multi-Specialty | |
No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | Group - Multi-Specialty | |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty | |
No | 385H00000X | Respite Care Facility | Respite Care | Group - Multi-Specialty | |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | Group - Multi-Specialty |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child | Group - Multi-Specialty |
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 1770014839 | Medicaid |