Provider Demographics
NPI:1952841769
Name:A.A SHEENA CARE LLC
Entity Type:Organization
Organization Name:A.A SHEENA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAKOUTE PANKUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-688-4525
Mailing Address - Street 1:3108 COLUMBIA PIKE, MEZZANINE FLOOR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204
Mailing Address - Country:US
Mailing Address - Phone:240-688-4525
Mailing Address - Fax:
Practice Address - Street 1:3108 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-4300
Practice Address - Country:US
Practice Address - Phone:240-688-4525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA163WR0006X, 251E00000X, 251J00000X, 320600000X, 320900000X, 332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
No251J00000XAgenciesNursing Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332U00000XSuppliersHome Delivered MealsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VASHEENAMedicaid