Provider Demographics
NPI:1669877940
Name:ACA HOME HEALTHCARE LLC.
Entity type:Organization
Organization Name:ACA HOME HEALTHCARE LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OKOLO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:757-405-3444
Mailing Address - Street 1:1508 AIRLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3907
Mailing Address - Country:US
Mailing Address - Phone:757-405-3444
Mailing Address - Fax:757-337-0901
Practice Address - Street 1:1508 AIRLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3907
Practice Address - Country:US
Practice Address - Phone:757-405-3444
Practice Address - Fax:757-337-0901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 385H00000X
VAHCO-14980251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0170870452Medicaid
VA2012215075Medicaid
VA10170869793Medicaid
VA2012215074Medicaid
VA3001508330004Medicaid
VA0170869793Medicaid
VAHCO-0000980OtherHOME HEALTH CARE