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General NPI Number Information
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NPI Number | 1861004491
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Entity Type | Organization
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Legal Business Name | INDEPENDENT LIVING HOME CARE L. L.C.
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Dates
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Enumeration Date | 08/17/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 6115 MANTLE RD
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City | BURKE
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State | VA
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Zip | 22015-3807
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Country | US
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Telephone | 267-252-1119
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Fax |
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Provider Business Mailing Address
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Address Line | 6115 MANTLE RD
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City | BURKE
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State | VA
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Zip | 22015-3807
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/VP
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Name | ALICIA GREEN
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Credential |
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Telephone | 267-252-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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