Provider Demographics
NPI: | 1881201861 |
---|---|
Name: | HOME CARE ASSOCIATES OF VA |
Entity Type: | Organization |
Organization Name: | HOME CARE ASSOCIATES OF VA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MAMUN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JITU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | HOME CARE |
Authorized Official - Phone: | 917-657-3705 |
Mailing Address - Street 1: | 24338 WINDING WILLOW CT |
Mailing Address - Street 2: | |
Mailing Address - City: | ALDIE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 20105-5941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 917-657-3705 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 24338 WINDING WILLOW CT |
Practice Address - Street 2: | |
Practice Address - City: | ALDIE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 20105-5941 |
Practice Address - Country: | US |
Practice Address - Phone: | 917-657-3705 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-09-24 |
Last Update Date: | 2020-09-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Single Specialty | |
No | 251E00000X | Agencies | Home Health | ||
No | 251J00000X | Agencies | Nursing Care |