Provider Demographics
NPI:1366742207
Name:EMMANUEL HOME CARE AGENCY LLC.
Entity type:Organization
Organization Name:EMMANUEL HOME CARE AGENCY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-660-6950
Mailing Address - Street 1:6911 RICHMOND HWY
Mailing Address - Street 2:SUITE 245
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-1842
Mailing Address - Country:US
Mailing Address - Phone:703-660-6950
Mailing Address - Fax:703-660-6290
Practice Address - Street 1:6911 RICHMOND HWY
Practice Address - Street 2:SUITE 245
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1842
Practice Address - Country:US
Practice Address - Phone:703-660-6950
Practice Address - Fax:703-660-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-11677251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health