=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972395622
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAREHOME LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2025
-----------------------------------------------------
Last Update Date | 07/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1110 S DICKENSON AVE
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20164-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-202-0185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24052 LENAH RIDGE PL
-----------------------------------------------------
City | ALDIE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20105-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-202-0185
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | LYNDA CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-202-0185
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------