Healthcare Provider Details

I. General information

NPI: 1629576947
Provider Name (Legal Business Name): ELABORATE HOME HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/21/2021
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6413 RIVINGTON RD
SPRINGFIELD VA
22152-2914
US

IV. Provider business mailing address

6413 RIVINGTON RD
SPRINGFIELD VA
22152-2914
US

V. Phone/Fax

Practice location:
  • Phone: 703-935-9442
  • Fax:
Mailing address:
  • Phone: 202-294-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE EYEGUE-SANDY
Title or Position: CEO/PRESIDENT
Credential: DNP, APRN, CRNP
Phone: 215-594-9392