Healthcare Provider Details

I. General information

NPI: 1043237845
Provider Name (Legal Business Name): ALL CARE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 NOR DAN DR
DANVILLE VA
24540-1612
US

IV. Provider business mailing address

242 NOR DAN DR
DANVILLE VA
24540-1612
US

V. Phone/Fax

Practice location:
  • Phone: 434-836-5883
  • Fax: 434-836-0254
Mailing address:
  • Phone: 434-836-5883
  • Fax: 434-836-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0001121009
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0001141653
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2305002760
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number2305002761
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0002046838
License Number StateVA

VIII. Authorized Official

Name: MR. TOMMY D. MATHENA
Title or Position: OWNER
Credential:
Phone: 434-836-5883