Healthcare Provider Details

I. General information

NPI: 1437941424
Provider Name (Legal Business Name): AJ ADVANCE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 PRINCETON TER SW
VIENNA VA
22180-6227
US

IV. Provider business mailing address

502 PRINCETON TER SW
VIENNA VA
22180-6227
US

V. Phone/Fax

Practice location:
  • Phone: 703-341-7121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ASHA JAMA
Title or Position: CEO
Credential:
Phone: 703-341-7121