Healthcare Provider Details

I. General information

NPI: 1205699246
Provider Name (Legal Business Name): A&E NOBLE CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 FOUNTAIN DR
STAFFORD VA
22554-7298
US

IV. Provider business mailing address

5 FOUNTAIN DR
STAFFORD VA
22554-7298
US

V. Phone/Fax

Practice location:
  • Phone: 540-659-3417
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VICTOR NYANKAH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 703-786-2317