Healthcare Provider Details

I. General information

NPI: 1407417819
Provider Name (Legal Business Name): AMAZING HOME CARE SERVICES VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 INTERNATIONAL DR STE 600
MC LEAN VA
22102-4877
US

IV. Provider business mailing address

1660 INTERNATIONAL DR STE 600
MC LEAN VA
22102-4877
US

V. Phone/Fax

Practice location:
  • Phone: 703-881-1989
  • Fax: 703-881-1989
Mailing address:
  • Phone: 703-881-1989
  • Fax: 703-881-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
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: LUZDARYS AVENDANO
Title or Position: DIRECTOR
Credential: HCO222081
Phone: 703-881-1989