Provider Demographics
NPI:1962607192
Name:ADORATION HOME HEALTH CARE VIRGINIA LLC
Entity type:Organization
Organization Name:ADORATION HOME HEALTH CARE VIRGINIA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-394-2321
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:502-630-7425
Mailing Address - Fax:
Practice Address - Street 1:165 PLAZA ROAD
Practice Address - Street 2:SUITE 20
Practice Address - City:WISE
Practice Address - State:VA
Practice Address - Zip Code:24293-4613
Practice Address - Country:US
Practice Address - Phone:276-679-6247
Practice Address - Fax:800-311-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VATO BE ISSUED251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA301483OtherANTHEM
VA497288Medicare Oscar/Certification