Provider Demographics
NPI:1992226344
Name:ARM BABY ELDERY HOME HEALTH LLC
Entity type:Organization
Organization Name:ARM BABY ELDERY HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MWANJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-729-9055
Mailing Address - Street 1:18909 RED OAK LN
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2122
Mailing Address - Country:US
Mailing Address - Phone:804-729-9055
Mailing Address - Fax:888-752-5586
Practice Address - Street 1:13000 HARBOR CENTER DR # 312C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192
Practice Address - Country:US
Practice Address - Phone:804-729-9055
Practice Address - Fax:888-752-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1741241251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2018009568Medicaid