=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447738430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AFFECTION HOME HEALTH CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2018
-----------------------------------------------------
Last Update Date | 08/23/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 FLANDERS ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22150-2450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-306-9833
-----------------------------------------------------
Fax | 571-730-4853
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5901 FLANDERS ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22150-2450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-306-9833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MOHOSINA JANNAT RIMI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-306-9833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HCO-191903
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | HCO-191903
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | HCO-191903
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------