Provider Demographics
NPI:1780821967
Name:OLD DOMINION HOME CARE,INC.
Entity Type:Organization
Organization Name:OLD DOMINION HOME CARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:AUGST
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:703-273-0422
Mailing Address - Street 1:10366 DEMOCRACY LN STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2530
Mailing Address - Country:US
Mailing Address - Phone:703-273-0422
Mailing Address - Fax:703-273-0423
Practice Address - Street 1:10366 DEMOCRACY LN STE C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2530
Practice Address - Country:US
Practice Address - Phone:703-273-0422
Practice Address - Fax:703-273-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09523251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health