1396298949 NPI number — AT HOME CARE STAFFING

Table of content: (NPI 1396298949)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396298949 NPI number — AT HOME CARE STAFFING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME CARE STAFFING
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:
1396298949
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 OLD RICHMOND AVE
Provider Second Line Business Mailing Address:
SUITE D -18
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-1828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-356-0631
Provider Business Mailing Address Fax Number:
804-612-3716

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 JEFFERSON HWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-6681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-358-0631
Provider Business Practice Location Address Fax Number:
804-612-3716
Provider Enumeration Date:
08/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KASSAB
Authorized Official First Name:
CURT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
804-358-0631

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HCO-171502 , 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: HCO-171502 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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