Healthcare Provider Details

I. General information

NPI: 1093011728
Provider Name (Legal Business Name): FAMILY HORIZONS HOME HEALTH CARE AGENCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 09/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 TYLER VON WAY SUITE 104
FREDERICKSBURG VA
22405-4517
US

IV. Provider business mailing address

205 TYLER VON WAY SUITE 104
FREDERICKSBURG VA
22405-4517
US

V. Phone/Fax

Practice location:
  • Phone: 540-318-8035
  • Fax: 540-318-6576
Mailing address:
  • Phone: 540-318-8035
  • Fax: 540-318-6576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DONNIEL JACKSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 540-318-8035