Provider Demographics
NPI:1649680448
Name:COMFORCARE OF NORTHERN VIRGINIA LLC
Entity type:Organization
Organization Name:COMFORCARE OF NORTHERN VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-938-3231
Mailing Address - Street 1:1604 SPRING HILL ROAD
Mailing Address - Street 2:STE 200
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-995-3595
Mailing Address - Fax:
Practice Address - Street 1:1604 SPRING HILL RD
Practice Address - Street 2:STE 200
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-7510
Practice Address - Country:US
Practice Address - Phone:703-995-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-141129251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health