Provider Demographics
NPI:1033595616
Name:CONGLAMORATE HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:CONGLAMORATE HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYSHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-277-2509
Mailing Address - Street 1:1036 32ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-3508
Mailing Address - Country:US
Mailing Address - Phone:757-247-1268
Mailing Address - Fax:757-247-0982
Practice Address - Street 1:1036 32ND ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-3508
Practice Address - Country:US
Practice Address - Phone:757-247-1268
Practice Address - Fax:757-247-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO161295251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO161295Medicaid