=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255681722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOMINION HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2012
-----------------------------------------------------
Last Update Date | 09/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7297 LEE HWY STE R
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22042-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-533-3060
-----------------------------------------------------
Fax | 703-533-3061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7297 LEE HWY STE R
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22042-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-533-3060
-----------------------------------------------------
Fax | 703-533-3061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RAJ CHAUDHRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-533-3060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------