1578648143 NPI number — ESPRIT HOMECARE LLC

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 1578648143 NPI number — ESPRIT HOMECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESPRIT HOMECARE 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:
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:
1578648143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 MILLER DR SE
Provider Second Line Business Mailing Address:
SUITE F1
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20175-8916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-777-3389
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 MILLER DR SE
Provider Second Line Business Practice Location Address:
SUITE F1
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20175-8916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-777-3389
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAGNE
Authorized Official First Name:
ZELALEM
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
703-998-7400

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0206008438 , 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: 299610 . This is a "AMERIGROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 573366 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 208902 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 009116389 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 485019 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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