Basic Information
| Provider Information | |||||||||
| NPI: | 1871813659 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BESTCARE HOME CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2070 OLD BRIDGE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221922495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034972273 | ||||||||
| FaxNumber: | 7033723259 | ||||||||
| Practice Location | |||||||||
| Address1: | 2070 OLD BRIDGE RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WOODBRIDGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221922495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034972273 | ||||||||
| FaxNumber: | 7033723259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | ASANTE | ||||||||
| AuthorizedOfficialFirstName: | EBENEZER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7034972273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 1871813659 | 05 | VA | MEDICAID |