Provider Demographics
NPI:1972730927
Name:KARLISE IN-HOME CARE, LLC
Entity Type:Organization
Organization Name:KARLISE IN-HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MOYE
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-842-2800
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:FORK UNION
Mailing Address - State:VA
Mailing Address - Zip Code:23055-0703
Mailing Address - Country:US
Mailing Address - Phone:434-842-2800
Mailing Address - Fax:434-842-2801
Practice Address - Street 1:6774 JAMES MADISON HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:FORK UNION
Practice Address - State:VA
Practice Address - Zip Code:23055-2084
Practice Address - Country:US
Practice Address - Phone:434-842-2800
Practice Address - Fax:434-842-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09578251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health