Healthcare Provider Details

I. General information

NPI: 1467219691
Provider Name (Legal Business Name): LIVE COMFORT HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

IV. Provider business mailing address

4330 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

V. Phone/Fax

Practice location:
  • Phone: 267-939-3119
  • Fax:
Mailing address:
  • Phone: 267-939-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KUTUBUL ALAM
Title or Position: ADMINISTRATOR
Credential:
Phone: 267-939-3119