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General NPI Number Information
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NPI Number | 1245663335
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Entity Type | Organization
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Legal Business Name | SOUTH HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 08/13/2013
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 4601 PINECREST OFFICE PARK DR STE F
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1442
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Country | US
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Telephone | 703-750-1101
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Fax | 703-750-1102
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Provider Business Mailing Address
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Address Line | 4601 PINECREST OFFICE PARK DR STE F
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1442
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Country | US
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Telephone | 703-750-1101
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Fax | 703-750-1102
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ASHA MOHAMUD ELMI
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Credential |
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Telephone | 703-750-1101
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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 | HCO-14989
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License Number State | VA
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