Provider Demographics
NPI:1194901694
Name:HOME HEALTH CONNECT
Entity type:Organization
Organization Name:HOME HEALTH CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:BODUNRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-226-5814
Mailing Address - Street 1:6969 RICHMOND HWY
Mailing Address - Street 2:#101
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1839
Mailing Address - Country:US
Mailing Address - Phone:703-768-7351
Mailing Address - Fax:703-768-7832
Practice Address - Street 1:6969 RICHMOND HWY
Practice Address - Street 2:#101
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1839
Practice Address - Country:US
Practice Address - Phone:703-768-7351
Practice Address - Fax:703-768-7832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-08278251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0151677264Medicaid
VA0151677421Medicaid