Healthcare Provider Details

I. General information

NPI: 1952110454
Provider Name (Legal Business Name): FIRST SUPPORT HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20937 ASHBURN RD STE 200
ASHBURN VA
20147-5663
US

IV. Provider business mailing address

20937 ASHBURN RD STE 200
ASHBURN VA
20147-5663
US

V. Phone/Fax

Practice location:
  • Phone: 571-690-7127
  • Fax:
Mailing address:
  • Phone: 571-690-7127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
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: SHERVINEH RASTGHALAM
Title or Position: DON/ADMINISTRATOR
Credential:
Phone: 571-690-7127