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General NPI Number Information
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NPI Number | 1114459609
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Entity Type | Organization
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Legal Business Name | LITTLE ROOSTER HOMECARE INC.
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 3100 CLARENDON BLVD #200
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City | ARLINGTON
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State | VA
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Zip | 22201-5330
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Country | US
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Telephone | 804-836-6956
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 CLARENDON BLVD #200
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City | ARLINGTON
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State | VA
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Zip | 22201-5330
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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 | STEVEN GENGER
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Credential |
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Telephone | 804-836-6956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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