1578704185 NPI number — AUTHENTIC HOME HEALTH SERVICES

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 1578704185 NPI number — AUTHENTIC HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTHENTIC HOME HEALTH SERVICES
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:
1578704185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANASSAS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20108-4752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-597-1378
Provider Business Mailing Address Fax Number:
703-651-5483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8471 IVY GLEN CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-4632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-597-1378
Provider Business Practice Location Address Fax Number:
703-651-5483
Provider Enumeration Date:
03/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABUNAW
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
703-597-1378

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0102614655 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".