=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265825699
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNCLE SAM'S HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2015
-----------------------------------------------------
Last Update Date | 02/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3223 VALLEY PIKE SUITE #3
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22602-5399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-980-5511
-----------------------------------------------------
Fax | 540-535-2083
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3223 VALLEY PIKE SUITE #3
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-980-5511
-----------------------------------------------------
Fax | 540-535-2083
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. SALIM SAYEGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-980-5511
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number | 023800
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------