Provider Demographics
NPI:1396054557
Name:COURTESY FIRST HOME CARE LLC
Entity type:Organization
Organization Name:COURTESY FIRST HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREYRA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:703-642-2385
Mailing Address - Street 1:5501 CHEROKEE AVE
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2305
Mailing Address - Country:US
Mailing Address - Phone:703-642-2385
Mailing Address - Fax:703-642-2583
Practice Address - Street 1:5501 CHEROKEE AVE
Practice Address - Street 2:SUITE # 202
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2305
Practice Address - Country:US
Practice Address - Phone:703-642-2385
Practice Address - Fax:703-642-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA372600000X385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0158680154Medicaid