Healthcare Provider Details

I. General information

NPI: 1861056145
Provider Name (Legal Business Name): KIND HEART INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 KING CENTRE DR STE 610
ALEXANDRIA VA
22315-5755
US

IV. Provider business mailing address

5680 KING CENTRE DR STE 610
ALEXANDRIA VA
22315-5755
US

V. Phone/Fax

Practice location:
  • Phone: 703-674-3821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIDIST FESSEHA
Title or Position: SENIOR MANAGER
Credential:
Phone: 703-647-3821