=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477880441
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT HOMECARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2009
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2066 JEFFERSON DAVIS HWY SUITE 209
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-7219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-658-9266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 PILGRIM CV
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-2036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-658-9266
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MISS JEMIMA E. SAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-658-9266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HC-09593
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------