Provider Demographics
NPI:1194810044
Name:ELISHAMA CARE SERVICES LLC
Entity type:Organization
Organization Name:ELISHAMA CARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:B N
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-717-0823
Mailing Address - Street 1:6801 RICHMOND HWY
Mailing Address - Street 2:SUITE#2
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1705
Mailing Address - Country:US
Mailing Address - Phone:703-717-0823
Mailing Address - Fax:703-717-0824
Practice Address - Street 1:6801 RICHMOND HWY
Practice Address - Street 2:SUITE#2
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1705
Practice Address - Country:US
Practice Address - Phone:703-717-0823
Practice Address - Fax:703-717-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07380251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health