Healthcare Provider Details

I. General information

NPI: 1114726320
Provider Name (Legal Business Name): KIZA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 SEMINARY RD APT 305
ALEXANDRIA VA
22311-1907
US

IV. Provider business mailing address

5001 SEMINARY RD APT 305
ALEXANDRIA VA
22311-1907
US

V. Phone/Fax

Practice location:
  • Phone: 202-301-3913
  • Fax:
Mailing address:
  • Phone: 202-978-3794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENIPHER ISAAC NAZARETH
Title or Position: CEO
Credential: BCBA
Phone: 771-201-9203