Provider Demographics
NPI:1538826821
Name:ESTHERS HOME CLINIC LLC
Entity type:Organization
Organization Name:ESTHERS HOME CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:H
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:571-247-7636
Mailing Address - Street 1:6829 GRINNEL LN
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-2731
Mailing Address - Country:US
Mailing Address - Phone:571-247-7636
Mailing Address - Fax:
Practice Address - Street 1:6829 GRINNEL LN
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-2731
Practice Address - Country:US
Practice Address - Phone:571-247-7636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-21
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty