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General NPI Number Information
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NPI Number | 1780821967
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Entity Type | Organization
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Legal Business Name | OLD DOMINION HOME CARE,INC.
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Dates
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Enumeration Date | 01/09/2009
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 10366 DEMOCRACY LN STE C
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City | FAIRFAX
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State | VA
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Zip | 22030-2530
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Country | US
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Telephone | 703-273-0422
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Fax | 703-273-0423
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Provider Business Mailing Address
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Address Line | 10366 DEMOCRACY LN STE C
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City | FAIRFAX
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State | VA
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Zip | 22030-2530
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Country | US
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Telephone | 703-273-0422
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Fax | 703-273-0423
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNETH RAYMOND AUGST III
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Credential |
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Telephone | 703-273-0422
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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-09523
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License Number State | VA
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