Healthcare Provider Details

I. General information

NPI: 1881447720
Provider Name (Legal Business Name): QUALITY HOME CARE GIVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4504 GASTON ST
CHANTILLY VA
20151-2244
US

IV. Provider business mailing address

4504 GASTON ST
CHANTILLY VA
20151-2244
US

V. Phone/Fax

Practice location:
  • Phone: 202-702-1642
  • Fax:
Mailing address:
  • Phone: 202-702-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ASHISH SANGROULA
Title or Position: FINANCIAL MANAGER
Credential: MSIT
Phone: 202-702-1642