Provider Demographics
NPI:1952775181
Name:POTOMAC HOME HEALTH LLC
Entity Type:Organization
Organization Name:POTOMAC HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MADAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPRETY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-623-5592
Mailing Address - Street 1:441 CARLISLE DR STE B
Mailing Address - Street 2:203
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4837
Mailing Address - Country:US
Mailing Address - Phone:703-623-5592
Mailing Address - Fax:866-470-3118
Practice Address - Street 1:441 CARLISLE DR STE B
Practice Address - Street 2:203
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4837
Practice Address - Country:US
Practice Address - Phone:703-623-5592
Practice Address - Fax:866-470-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health