Basic Information
| Provider Information | |||||||||
| NPI: | 1710955489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADORATION HOME HEALTH CARE VIRGINIA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED HOME HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 N WHITTINGTON PKWY | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402227101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026307425 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9731 SOUTHERN PINE BLVD STE L | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282735542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048315000 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PEMBERTON | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5022723466 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 13151 | 01 | NC | PARTNERS | OTHER | 007CR | 01 | NC | BCBSNC | OTHER | 1027449 | 01 | NC | UHC ACM | OTHER | 3427114 | 05 | NC | MEDICAID |