Provider Demographics
NPI:1962037838
Name:CENTRAL BASE HOME HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CENTRAL BASE HOME HEALTHCARE, LLC
Other - Org Name:CARELINX HOME HEALTHCARE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, SERVICES FACILITATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-718-3551
Mailing Address - Street 1:5901 KINGSTOWNE VILLAGE PARKWAY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5882
Mailing Address - Country:US
Mailing Address - Phone:703-718-3551
Mailing Address - Fax:703-417-9931
Practice Address - Street 1:5901 KINGSTOWNE VILLAGE PARKWAY
Practice Address - Street 2:SUITE #201
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5882
Practice Address - Country:US
Practice Address - Phone:703-718-3551
Practice Address - Fax:703-417-9931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL BASE HOME HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-11
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1962037838Medicaid