Healthcare Provider Details

I. General information

NPI: 1487420790
Provider Name (Legal Business Name): ABDI HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11448 KINGS POND DR STE OFFICE
PROVIDENCE FORGE VA
23140-4465
US

IV. Provider business mailing address

11448 KINGS POND DR STE OFFICE
PROVIDENCE FORGE VA
23140-4465
US

V. Phone/Fax

Practice location:
  • Phone: 804-557-4510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE HALLIGAN
Title or Position: PRESIDENT
Credential:
Phone: 804-506-0701