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General NPI Number Information
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NPI Number | 1730959248
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Entity Type | Organization
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Legal Business Name | SUBON HOME CARE AGENCY LLC
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Dates
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Enumeration Date | 01/05/2024
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 14325 WILLARD RD UNIT D
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City | CHANTILLY
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State | VA
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Zip | 20151-2110
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Country | US
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Telephone | 571-470-7541
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Fax | 571-444-6786
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Provider Business Mailing Address
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Address Line | 5602 TRUITT FARM CT
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City | CENTREVILLE
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State | VA
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Zip | 20120-5406
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Country | US
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Telephone | 571-470-7541
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Fax | 571-444-6786
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Authorized Official
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Title or Position | OWNER / ADMINISTRATOR
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Name | SUSAN KAITESI
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Credential |
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Telephone | 859-361-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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