Healthcare Provider Details

I. General information

NPI: 1477092989
Provider Name (Legal Business Name): HOME CARE SOLUTIONS, MID ATLANTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 350
SPRINGFIELD VA
22150-2519
US

IV. Provider business mailing address

816 E 3RD ST
FARMVILLE VA
23901-1608
US

V. Phone/Fax

Practice location:
  • Phone: 434-808-4205
  • Fax:
Mailing address:
  • Phone: 434-392-7336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. KEVIN ( DEE) DEWITT
Title or Position: CFO
Credential:
Phone: 434-392-7336