Provider Demographics
NPI:1922473263
Name:FORECASTLE PROFESSIONAL AND HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:FORECASTLE PROFESSIONAL AND HOME HEALTH SERVICES, LLC
Other - Org Name:FORECASTLE HOME AND HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RODDY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-537-9776
Mailing Address - Street 1:104 PROVIDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6168
Mailing Address - Country:US
Mailing Address - Phone:703-649-4494
Mailing Address - Fax:
Practice Address - Street 1:117 W BOSCAWEN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4140
Practice Address - Country:US
Practice Address - Phone:703-649-4494
Practice Address - Fax:540-486-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-12
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251B00000X, 251E00000X
253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care