MEDICARE: ACTIVE HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	385H00000X	Respite Care
2	3747P1801X	Personal Care Attendant
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679030704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	5881 LEESBURG PIKE SUITE 205
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:	571-277-0173
Fax Number	:	703-940-8009

Provider Business Practice Location Address
First Line	:	5881 LEESBURG PIKE SUITE 205
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2312
Country	:	US
Telephone Number	:	571-277-0173
Fax Number	:	703-940-8009

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. ABDIAZIZ OMAR HUSSEIN
Credential	:	OWNER
Telephone Number	:	571-277-0173

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	11/07/2025

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Directions to “ACTIVE HOME CARE SERVICES LLC ” Practice Location

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