Healthcare Provider Details

I. General information

NPI: 1972730927
Provider Name (Legal Business Name): KARLISE IN-HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6774 JAMES MADISON HWY SUITE 400
FORK UNION VA
23055-2084
US

IV. Provider business mailing address

PO BOX 703
FORK UNION VA
23055-0703
US

V. Phone/Fax

Practice location:
  • Phone: 434-842-2800
  • Fax: 434-842-2801
Mailing address:
  • Phone: 434-842-2800
  • Fax: 434-842-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-09578
License Number StateVA

VIII. Authorized Official

Name: MRS. AMANDA MOYE RANDOLPH
Title or Position: CEO/PRESIDENT
Credential:
Phone: 434-842-2800