=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629326533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME CARE ASSISTANCE OF VIRGINIA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2012
-----------------------------------------------------
Last Update Date | 08/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6723 CURRAN ST
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-356-4333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6723 CURRAN ST
-----------------------------------------------------
City | MC LEAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22101-3804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-356-4333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KENNETH HANSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-356-4333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | HCO-13558
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------