Provider Demographics
NPI:1891327417
Name:PERFECT HOME SUPPORT, LLC
Entity Type:Organization
Organization Name:PERFECT HOME SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILOMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-320-5583
Mailing Address - Street 1:13662 OFFICE PL STE 104
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4217
Mailing Address - Country:US
Mailing Address - Phone:571-320-5583
Mailing Address - Fax:
Practice Address - Street 1:13662 OFFICE PL STE 104
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4217
Practice Address - Country:US
Practice Address - Phone:571-320-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities