Healthcare Provider Details

I. General information

NPI: 1558677591
Provider Name (Legal Business Name): RG HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5023 BACKLICK RD SUITE B
ANNANDALE VA
22003
US

IV. Provider business mailing address

5023 BACKLICK RD SUITE B
ANNANDALE VA
22003
US

V. Phone/Fax

Practice location:
  • Phone: 703-333-5103
  • Fax: 703-333-5104
Mailing address:
  • Phone: 703-333-5103
  • Fax: 703-333-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1044012
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. RICARDO EDUBERTO GIRON
Title or Position: OWNER
Credential:
Phone: 703-333-5103