Healthcare Provider Details

I. General information

NPI: 1699508069
Provider Name (Legal Business Name): IDEAL HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 YEW GROVE PL
DUMFRIES VA
22026-2742
US

IV. Provider business mailing address

3121 YEW GROVE PL
DUMFRIES VA
22026-2742
US

V. Phone/Fax

Practice location:
  • Phone: 571-277-7111
  • Fax:
Mailing address:
  • Phone: 571-277-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HARRISON IGWE
Title or Position: CEO
Credential:
Phone: 571-435-5296