MEDICARE: ULTRACARE HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3747P1801X	Personal Care Attendant
2	385H00000X	Respite Care
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225875255
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRACARE HOME CARE LLC

Provider Business Mailing Address
First Line	:	104 CORAL REEF CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-4506
Country	:	US
Telephone Number	:	571-382-8410
Fax Number	:	571-382-8000

Provider Business Practice Location Address
First Line	:	104 CORAL REEF CT
Second Line	:
City	:	STAFFORD
State	:	VA
Zip	:	22554-4506
Country	:	US
Telephone Number	:	571-382-8410
Fax Number	:	571-382-8000

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANITA OBENEWA AMOANI
Credential	:
Telephone Number	:	571-382-8410

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	01/09/2025

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