Healthcare Provider Details

I. General information

NPI: 1598070880
Provider Name (Legal Business Name): EMMANUEL HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6911 RICHMOND HWY SUITE 245
ALEXANDRIA VA
22306-1842
US

IV. Provider business mailing address

6911 RICHMOND HWY SUITE 245
ALEXANDRIA VA
22306-1842
US

V. Phone/Fax

Practice location:
  • Phone: 703-660-6950
  • Fax:
Mailing address:
  • Phone: 703-660-6950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberHCO-12677
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-11677
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberHCO-12677
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberHC0-12677
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberHCO-12677
License Number StateVA

VIII. Authorized Official

Name: MR. JOSEPH ADETUNJI
Title or Position: FINANCE MANAGER
Credential:
Phone: 703-660-6950