Provider Demographics
NPI:1982398483
Name:FOBETER HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:FOBETER HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GWANNULLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-407-0695
Mailing Address - Street 1:13311 POINT PLEASANT DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3514
Mailing Address - Country:US
Mailing Address - Phone:202-407-0695
Mailing Address - Fax:
Practice Address - Street 1:13311 POINT PLEASANT DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-3514
Practice Address - Country:US
Practice Address - Phone:202-407-0695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care