Provider Demographics
NPI:1245607886
Name:ADVANCED HOME CARE CONNECT INC
Entity type:Organization
Organization Name:ADVANCED HOME CARE CONNECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:ABDULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-477-9568
Mailing Address - Street 1:13190 CENTERPOINTE WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5286
Mailing Address - Country:US
Mailing Address - Phone:571-477-9568
Mailing Address - Fax:
Practice Address - Street 1:5578 NEDDLETON AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4165
Practice Address - Country:US
Practice Address - Phone:571-477-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-161345251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health