Healthcare Provider Details

I. General information

NPI: 1881025492
Provider Name (Legal Business Name): CANAAN CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2013
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S KING ST
LEESBURG VA
20175-2905
US

IV. Provider business mailing address

211 S KING ST
LEESBURG VA
20175-2905
US

V. Phone/Fax

Practice location:
  • Phone: 703-297-8425
  • Fax: 703-348-7510
Mailing address:
  • Phone: 703-297-8425
  • Fax: 703-348-7510

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: VIVIANE ATCHOU
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-297-8425