Healthcare Provider Details

I. General information

NPI: 1629585674
Provider Name (Legal Business Name): CUADRO HOME CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14192 CHAPMANS LN
CARROLLTON VA
23314
US

IV. Provider business mailing address

14192 CHAPMANS LN
CARROLLTON VA
23314-9718
US

V. Phone/Fax

Practice location:
  • Phone: 757-560-6466
  • Fax:
Mailing address:
  • Phone: 757-560-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER BOPHACHAN TEP-CUADRO
Title or Position: PRESIDENT/OWNER
Credential: PHARMD
Phone: 757-560-6466