Provider Demographics
NPI:1285871228
Name:CARE AT HOME LLC
Entity type:Organization
Organization Name:CARE AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:571-237-3842
Mailing Address - Street 1:800 3RD ST
Mailing Address - Street 2:250
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3272
Mailing Address - Country:US
Mailing Address - Phone:571-237-3842
Mailing Address - Fax:
Practice Address - Street 1:800 3RD ST
Practice Address - Street 2:250
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3272
Practice Address - Country:US
Practice Address - Phone:571-237-3842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-09512251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care