Healthcare Provider Details

I. General information

NPI: 1306657143
Provider Name (Legal Business Name): SWEET VIRGINIA CARE DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5247 WISCONSIN AVE NW STE 3B
WASHINGTON DC
20015-2012
US

IV. Provider business mailing address

21035 SYCOLIN RD STE 55
ASHBURN VA
20147-4311
US

V. Phone/Fax

Practice location:
  • Phone: 703-496-4616
  • Fax: 703-496-4615
Mailing address:
  • Phone: 703-496-4616
  • Fax: 703-496-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN CONRAD
Title or Position: DIRECTOR
Credential:
Phone: 703-496-4616