Healthcare Provider Details

I. General information

NPI: 1558132753
Provider Name (Legal Business Name): BOM CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 MATHY DR STE 360
FAIRFAX VA
22031-5333
US

IV. Provider business mailing address

9401 MATHY DR STE 360
FAIRFAX VA
22031-5333
US

V. Phone/Fax

Practice location:
  • Phone: 703-859-2523
  • Fax:
Mailing address:
  • Phone: 703-859-2523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: YUNG SOOK JANG
Title or Position: ALTERNATE ADMINISTRATOR
Credential:
Phone: 703-200-9150