Healthcare Provider Details

I. General information

NPI: 1669877940
Provider Name (Legal Business Name): ACA HOME HEALTHCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 06/12/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 AIRLINE BLVD
PORTSMOUTH VA
23707-3907
US

IV. Provider business mailing address

1508 AIRLINE BLVD
PORTSMOUTH VA
23707-3907
US

V. Phone/Fax

Practice location:
  • Phone: 757-405-3444
  • Fax: 757-337-0901
Mailing address:
  • Phone: 757-405-3444
  • Fax: 757-337-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-14980
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. FAYE K OKOLO
Title or Position: ADMINISTRATOR
Credential: OWNER
Phone: 757-405-3444