Provider Demographics
NPI:1205351145
Name:EXPERIENCARE LLC
Entity type:Organization
Organization Name:EXPERIENCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JAHANGIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-338-0285
Mailing Address - Street 1:5338 BOWERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4510
Mailing Address - Country:US
Mailing Address - Phone:703-338-0285
Mailing Address - Fax:
Practice Address - Street 1:502 MCKNIGHT DR STE 101
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7050
Practice Address - Country:US
Practice Address - Phone:703-338-0878
Practice Address - Fax:703-991-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-12
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No273100000XHospital UnitsEpilepsy Unit
No292200000XLaboratoriesDental Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies