Provider Demographics
NPI:1396103313
Name:AGNES HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:AGNES HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNJU
Authorized Official - Middle Name:
Authorized Official - Last Name:JI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-642-5000
Mailing Address - Street 1:14631 LEE HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5825
Mailing Address - Country:US
Mailing Address - Phone:703-642-5000
Mailing Address - Fax:703-642-5005
Practice Address - Street 1:14631 LEE HWY STE 103
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5825
Practice Address - Country:US
Practice Address - Phone:703-642-5000
Practice Address - Fax:703-642-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 385H00000X
VAHCO-161401251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No385H00000XRespite Care FacilityRespite Care