Healthcare Provider Details

I. General information

NPI: 1124424775
Provider Name (Legal Business Name): ENTYRE CARE VIRGINIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 WILSON BLVD FL 3
ARLINGTON VA
22203-4420
US

IV. Provider business mailing address

4201 WILSON BLVD FL 3
ARLINGTON VA
22203-4420
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-8818
  • Fax: 703-273-8874
Mailing address:
  • Phone: 703-273-8818
  • Fax: 703-273-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO15660
License Number StateVA

VIII. Authorized Official

Name: ANTONIA WISSENBACH
Title or Position: GENERAL MANAGER
Credential:
Phone: 804-596-6468