Provider Demographics
NPI:1922544774
Name:NICE HOME CARE, LLC
Entity Type:Organization
Organization Name:NICE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARAEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-901-7561
Mailing Address - Street 1:3601 PICKETT RD
Mailing Address - Street 2:SUITE 2773
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-8100
Mailing Address - Country:US
Mailing Address - Phone:703-901-7561
Mailing Address - Fax:
Practice Address - Street 1:3601 PICKETT RD
Practice Address - Street 2:SUITE 2773
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-8100
Practice Address - Country:US
Practice Address - Phone:703-901-7561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
S6552840251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid