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General NPI Number Information
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NPI Number | 1649680448
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Entity Type | Organization
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Legal Business Name | COMFORCARE OF NORTHERN VIRGINIA LLC
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 1604 SPRING HILL RD STE 200
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City | VIENNA
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State | VA
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Zip | 22182-7510
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Country | US
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Telephone | 703-995-3595
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 SPRING HILL ROAD STE 200
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City | VIENNA
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State | VA
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Zip | 22182
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Country | US
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Telephone | 703-995-3595
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. CARA MONGELLI
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Credential |
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Telephone | 301-938-3231
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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-141129
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License Number State | VA
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