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Organization
AT HOME CAREGIVERS
Active
Organization
AT HOME CAREGIVERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE RAYMOND PUCKETT JR. (OWNER)
(540) 206-3364
Entity
Organization
Contact information
Practice address
90 TOWN CENTER ST, SUITE 201, DALEVILLE, VA 24083-3741
(540) 206-3364
(540) 206-3367
Mailing address
90 TOWN CENTER ST, SUITE 201, DALEVILLE, VA 24083-3741
(540) 206-3364
(540) 206-3367
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HCO-141036
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HCO-141036
VIRGINIA HOME CARE ORGANIZATION LICENSE
VA
Enumeration date
01/27/2014
Last updated
01/27/2014
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