=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659753242
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOME HEALTH PLUS OF VIRGINIA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2015
-----------------------------------------------------
Last Update Date | 02/20/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1924 ARLINGTON BLVD SUITE 100
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22903-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-984-0303
-----------------------------------------------------
Fax | 434-984-0330
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1924 ARLINGTON BLVD SUITE 100
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22903-1533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-984-0303
-----------------------------------------------------
Fax | 434-984-0330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURA COLEMAN
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 434-984-0303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------