Healthcare Provider Details

I. General information

NPI: 1730959248
Provider Name (Legal Business Name): SUBON HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14325 WILLARD RD UNIT D
CHANTILLY VA
20151-2110
US

IV. Provider business mailing address

5602 TRUITT FARM CT
CENTREVILLE VA
20120-5406
US

V. Phone/Fax

Practice location:
  • Phone: 571-470-7541
  • Fax: 571-444-6786
Mailing address:
  • Phone: 571-470-7541
  • Fax: 571-444-6786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SUSAN KAITESI
Title or Position: OWNER / ADMINISTRATOR
Credential:
Phone: 859-361-9000