Provider Demographics
NPI:1972957108
Name:AAA HEALTHCARE LLC
Entity Type:Organization
Organization Name:AAA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ISMAIL
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:571-839-2662
Mailing Address - Street 1:464 HERNDON PKWY
Mailing Address - Street 2:SUITE-216
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5290
Mailing Address - Country:US
Mailing Address - Phone:703-435-7402
Mailing Address - Fax:703-689-3862
Practice Address - Street 1:464 HERNDON PKWY
Practice Address - Street 2:SUITE-216
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5290
Practice Address - Country:US
Practice Address - Phone:703-435-7402
Practice Address - Fax:703-689-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health