Healthcare Provider Details

I. General information

NPI: 1326558727
Provider Name (Legal Business Name): CARE AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6834 COLEMANS CROSSING AVE STE E
HAYES VA
23072-3337
US

IV. Provider business mailing address

6834 COLEMANS CROSSING AVE STE E
HAYES VA
23072-3337
US

V. Phone/Fax

Practice location:
  • Phone: 804-210-1333
  • Fax: 804-210-1550
Mailing address:
  • Phone: 804-210-1333
  • Fax: 804-210-1550

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHCO-181294
License Number StateVA

VIII. Authorized Official

Name: EBONY BROOKE NICKENS
Title or Position: MANAGER
Credential:
Phone: 804-210-1333