1710955489 NPI number — ADORATION HOME HEALTH CARE VIRGINIA LLC

Table of content: (NPI 1710955489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710955489 NPI number — ADORATION HOME HEALTH CARE VIRGINIA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADORATION HOME HEALTH CARE VIRGINIA LLC
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:
6
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:
1710955489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
805 N WHITTINGTON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-630-7138
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5200 77 CENTER DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28217-0704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-831-5001
Provider Business Practice Location Address Fax Number:
800-311-7783
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTINGLY
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR LICENSURE AND ENROLLMENT
Authorized Official Telephone Number:
502-630-7138

Provider Taxonomy Codes

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

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

  • Identifier: 3427114 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007CR . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1027449 . This is a "UHC ACM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 13151 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com