Basic Information
| Provider Information | |||||||||
| NPI: | 1477894699 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BENNETT HOME CARE AGENCY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 LANDINGS POINT LOOP | ||||||||
| Address2: | #204 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221914259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035976529 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2700 LANDINGS POINT LOOP | ||||||||
| Address2: | #204 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221914259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035976529 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2013 | ||||||||
| LastUpdateDate: | 03/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | FYNN | ||||||||
| AuthorizedOfficialFirstName: | ABENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7035976529 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.