Healthcare Provider Details

I. General information

NPI: 1225875255
Provider Name (Legal Business Name): ULTRACARE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CORAL REEF CT
STAFFORD VA
22554-4506
US

IV. Provider business mailing address

104 CORAL REEF CT
STAFFORD VA
22554-4506
US

V. Phone/Fax

Practice location:
  • Phone: 571-382-8410
  • Fax: 571-382-8000
Mailing address:
  • Phone: 571-382-8410
  • Fax: 571-382-8000

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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANITA OBENEWA AMOANI
Title or Position: ADMINISTRATOR
Credential:
Phone: 571-382-8410