Provider Demographics
NPI:1194112565
Name:HOMEBASED HOMESERVICES CAREGIVER
Entity type:Organization
Organization Name:HOMEBASED HOMESERVICES CAREGIVER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:ODEMNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:240-350-3053
Mailing Address - Street 1:1940 DUKE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3451
Mailing Address - Country:US
Mailing Address - Phone:703-553-2536
Mailing Address - Fax:703-548-9446
Practice Address - Street 1:1940 DUKE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3451
Practice Address - Country:US
Practice Address - Phone:703-553-2536
Practice Address - Fax:703-548-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health