Healthcare Provider Details

I. General information

NPI: 1043900418
Provider Name (Legal Business Name): OLD GLORY HOME HEALTH CARE & ASSISTIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 W LABURNUM AVE STE 230
RICHMOND VA
23227-4300
US

IV. Provider business mailing address

2108 W LABURNUM AVE STE 230 SUITE 230
RICHMOND VA
23227-4300
US

V. Phone/Fax

Practice location:
  • Phone: 804-599-7868
  • Fax:
Mailing address:
  • Phone: 804-269-0637
  • Fax: 804-441-7346

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KIM FOSTER
Title or Position: OWNER
Credential:
Phone: 804-599-7868