MEDICARE: KISSINGER HEALTHCARE ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant	HCO-17622	VA
2	372600000X	Adult Companion
3	376J00000X	Homemaker	HCO-17622	VA
4	376K00000X	Nurse's Aide	HCO-17622	VA
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1407377682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISSINGER HEALTHCARE ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	3921 OLD LEE HWY STE 71C
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-992-7420
Fax Number	:	703-992-7402

Provider Business Practice Location Address
First Line	:	3921 OLD LEE HWY STE 71C
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-992-7420
Fax Number	:	703-992-7402

Authorized Official
Title or Position	:	MEMBER & ADMINISTRATOR
Name	:	DONALD KISSINGER
Credential	:	CPA, JD, LL.M.
Telephone Number	:	703-992-7420

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	07/21/2022

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