MEDICARE: ANTHEM HOME HEALTHCARE AGENCY

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

General Provider Information

NPI Number	:	1730723545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHEM HOME HEALTHCARE AGENCY

Provider Business Mailing Address
First Line	:	4901 WALLER RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2913
Country	:	US
Telephone Number	:	702-300-2561
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 WALLER RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-2913
Country	:	US
Telephone Number	:	702-300-2561
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	BRITTNEY CARTER
Credential	:
Telephone Number	:	702-300-2561

Provider Enumeration Date	:	11/05/2019
Last Update Date	:	11/05/2019

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