Provider Demographics
NPI:1861083131
Name:ADVANCED HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:ADVANCED HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-962-7797
Mailing Address - Street 1:4222 FORTUNA CENTER PLZ # 211
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-1515
Mailing Address - Country:US
Mailing Address - Phone:703-962-7797
Mailing Address - Fax:
Practice Address - Street 1:4222 FORTUNA CENTER PLZ # 211
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22025-1515
Practice Address - Country:US
Practice Address - Phone:703-962-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-212475OtherVDH HCO LICENSE