Provider Demographics
NPI:1811338791
Name:ROYAL HOME CARE LLC
Entity type:Organization
Organization Name:ROYAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-992-9032
Mailing Address - Street 1:6381 LITTLE RIVER TPKE STE 6
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-5002
Mailing Address - Country:US
Mailing Address - Phone:703-992-9032
Mailing Address - Fax:
Practice Address - Street 1:6381 LITTLE RIVER TPKE
Practice Address - Street 2:SECOND FLOOR SUITE 6
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-5002
Practice Address - Country:US
Practice Address - Phone:703-992-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:N3O ENTERPRISES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-09
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-171038Medicaid