Provider Demographics
NPI:1710955489
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:DIRECTOR LICENSURE AND ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTINGLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7138
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:502-630-7138
Mailing Address - Fax:
Practice Address - Street 1:5200 77 CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-0704
Practice Address - Country:US
Practice Address - Phone:704-831-5001
Practice Address - Fax:800-311-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3427114Medicaid
NC007CROtherBCBSNC
NC1027449OtherUHC ACM
NC13151OtherPARTNERS
NC13151OtherPARTNERS