1467772020 NPI number — FAMILY HORIZONS HOME HEALTH CARE AGENCY INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467772020 NPI number — FAMILY HORIZONS HOME HEALTH CARE AGENCY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HORIZONS HOME HEALTH CARE AGENCY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467772020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 TYLER VON WAY
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22405-4517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-318-8035
Provider Business Mailing Address Fax Number:
540-318-6576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 TYLER VON WAY
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22405-4517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-318-8035
Provider Business Practice Location Address Fax Number:
540-318-6576
Provider Enumeration Date:
06/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
DONNIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
540-429-5027

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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