# CLASSIC CAREGIVERS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Classic Caregivers
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417373622
- **Authorized official:** MS. LISA KERSHES (OWNER)
- **Authorized official phone:** (877) 201-4579

## Contact information

- **Practice address:** 6506 ROCK CRYSTAL DR, CLIFTON, VA 20124-2520
- **Practice address phone:** (877) 201-4579
- **Practice address fax:** (703) 520-2802
- **Mailing address:** 6506 ROCK CRYSTAL DR, CLIFTON, VA 20124-2520
- **Mailing address phone:** (877) 201-4579
- **Mailing address fax:** (703) 520-2802

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | HCO151201 | VA | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 03/12/2014
- **Last updated:** 09/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1355991 | FAIRFAX COUNTY BUSINESS, PROFESSIONAL & OCCUPATIONAL LICENSE | VA |
| 01 | — | HCO151201 | VDOH | VA |