MEDICARE: EMMANUEL HOME CARE AGENCY LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HCO-11677	VA

General Provider Information

NPI Number	:	1366742207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL HOME CARE AGENCY LLC.

Provider Business Mailing Address
First Line	:	6911 RICHMOND HWY
Second Line	:	SUITE 245
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-660-6950
Fax Number	:	703-660-6290

Provider Business Practice Location Address
First Line	:	6911 RICHMOND HWY
Second Line	:	SUITE 245
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-1842
Country	:	US
Telephone Number	:	703-660-6950
Fax Number	:	703-660-6290

Authorized Official
Title or Position	:	FINANCIAL MANAGER
Name	:	MR. JOSEPH A ADETUNJI
Credential	:
Telephone Number	:	703-660-6950

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	03/29/2011

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