Provider Demographics
NPI:1316314941
Name:WASHINGTON HOME HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:WASHINGTON HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-218-7280
Mailing Address - Street 1:3402 WISCONSIN AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5378
Mailing Address - Country:US
Mailing Address - Phone:601-218-7280
Mailing Address - Fax:601-501-1168
Practice Address - Street 1:3402 WISCONSIN AVE STE 10
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5378
Practice Address - Country:US
Practice Address - Phone:601-218-7280
Practice Address - Fax:601-501-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care