Healthcare Provider Details

I. General information

NPI: 1285871228
Provider Name (Legal Business Name): CARE AT HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 3RD ST 250
HERNDON VA
20170-3272
US

IV. Provider business mailing address

800 3RD ST 250
HERNDON VA
20170-3272
US

V. Phone/Fax

Practice location:
  • Phone: 571-237-3842
  • Fax:
Mailing address:
  • Phone: 571-237-3842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-09512
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO-09512
License Number StateVA

VIII. Authorized Official

Name: DR. SAMUELL ADDY
Title or Position: OWNER/ADMINISTRATOR
Credential: PHARM.D.
Phone: 571-237-3842