Healthcare Provider Details

I. General information

NPI: 1174310379
Provider Name (Legal Business Name): ULTIMATE COMFORT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 DAISY REID AVE STE 128J
LAKE RIDGE VA
22192-5671
US

IV. Provider business mailing address

4565 DAISY REID AVE STE 128J
LAKE RIDGE VA
22192-5671
US

V. Phone/Fax

Practice location:
  • Phone: 540-530-4838
  • Fax: 571-668-4528
Mailing address:
  • Phone: 540-530-4838
  • Fax: 571-668-4528

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JULIANA ADEGBITE
Title or Position: DIRECTOR
Credential:
Phone: 240-422-3946