Healthcare Provider Details

I. General information

NPI: 1619118528
Provider Name (Legal Business Name): FIVE STAR HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 ALBEMARLE POINT PL STE 150
CHANTILLY VA
20151-1690
US

IV. Provider business mailing address

14420 ALBEMARLE POINT PL STE 150
CHANTILLY VA
20151-1690
US

V. Phone/Fax

Practice location:
  • Phone: 703-662-7500
  • Fax: 703-661-6397
Mailing address:
  • Phone: 703-662-7500
  • Fax: 703-661-6397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberJCAHO 518135
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberJCAHO 518135
License Number StateVA

VIII. Authorized Official

Name: JOHNNY L WILKINSON
Title or Position: CEO
Credential:
Phone: 703-662-7500