Healthcare Provider Details

I. General information

NPI: 1376074575
Provider Name (Legal Business Name): ONE CARE VA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 FAIRFAX DR 1200
ARLINGTON VA
22203-1500
US

IV. Provider business mailing address

8400 BUSTLETON AVE 307
PHILADELPHIA PA
19152-1918
US

V. Phone/Fax

Practice location:
  • Phone: 240-506-9577
  • Fax:
Mailing address:
  • Phone: 240-506-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-171600
License Number StateVA

VIII. Authorized Official

Name: MATUTU NYABANGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-506-9577