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General NPI Number Information
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NPI Number | 1043900418
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Entity Type | Organization
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Legal Business Name | OLD GLORY HOME HEALTH CARE & ASSISTIVE CARE
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 2108 W LABURNUM AVE STE 230
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City | RICHMOND
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State | VA
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Zip | 23227-4300
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Country | US
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Telephone | 804-599-7868
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 W LABURNUM AVE STE 230
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City | RICHMOND
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State | VA
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Zip | 23227-4300
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM FOSTER
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Credential |
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Telephone | 804-599-7868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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