Healthcare Provider Details

I. General information

NPI: 1821599523
Provider Name (Legal Business Name): MY HOME COMPANION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL ROAD B-308
SPRINGFIELD VA
22031
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD STE B308
SPRINGFIELD VA
22152-1857
US

V. Phone/Fax

Practice location:
  • Phone: 833-286-9466
  • Fax: 571-348-1264
Mailing address:
  • Phone: 833-286-9466
  • 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 Code374T00000X
TaxonomyReligious Nonmedical Nursing Personnel
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHCO-1800
License Number StateVA

VIII. Authorized Official

Name: MR. ROBERT F CARLIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-919-8811