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General NPI Number Information
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NPI Number | 1275022295
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Entity Type | Organization
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Legal Business Name | CENTRE HOME CARE LLC
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 05/04/2018
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Provider Practice Location Address
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Address Line | 6601 LITTLE RIVER TPKE STE 240
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1316
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Country | US
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Telephone | 571-333-3015
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Fax |
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Provider Business Mailing Address
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Address Line | 6601 LITTLE RIVER TPKE STE 240
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City | ALEXANDRIA
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State | VA
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Zip | 22312-1316
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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 | ACCOUNTANT
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Name | RICHARD U BANGURA
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Credential |
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Telephone | 703-342-7827
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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-181187
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License Number State | VA
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