Healthcare Provider Details

I. General information

NPI: 1376426510
Provider Name (Legal Business Name): AG HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5508 GARY AVE
ALEXANDRIA VA
22311-1502
US

IV. Provider business mailing address

5508 GARY AVE
ALEXANDRIA VA
22311-1502
US

V. Phone/Fax

Practice location:
  • Phone: 571-675-5801
  • Fax: 703-995-4435
Mailing address:
  • Phone: 571-675-5801
  • Fax: 703-995-4435

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: ABBY GURARA
Title or Position: OWNER
Credential: AG HOME CARE LLC
Phone: 571-675-5801