Provider Demographics
NPI:1245663335
Name:SOUTH HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:SOUTH HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:MOHAMUD
Authorized Official - Last Name:ELMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-750-1101
Mailing Address - Street 1:4601 PINECREST OFFICE PARK DR STE F
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1442
Mailing Address - Country:US
Mailing Address - Phone:703-750-1101
Mailing Address - Fax:703-750-1102
Practice Address - Street 1:4601 PINECREST OFFICE PARK DR STE F
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1442
Practice Address - Country:US
Practice Address - Phone:703-750-1101
Practice Address - Fax:703-750-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-14989251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health