Healthcare Provider Details

I. General information

NPI: 1700603479
Provider Name (Legal Business Name): AMENDED HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 COOPERATIVE WAY STE 600
HERNDON VA
20171-3005
US

IV. Provider business mailing address

2201 COOPERATIVE WAY STE 600
HERNDON VA
20171-3005
US

V. Phone/Fax

Practice location:
  • Phone: 571-356-1538
  • Fax: 703-935-1364
Mailing address:
  • Phone: 571-356-1538
  • Fax: 703-935-1364

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: RAJIB HOQ
Title or Position: ADMINISTRATOR
Credential:
Phone: 571-356-1538