Healthcare Provider Details

I. General information

NPI: 1639843949
Provider Name (Legal Business Name): ROSA MYSTICA PROFESSIONAL HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COURTHOUSE RD APT 127
ARLINGTON VA
22204-6258
US

IV. Provider business mailing address

1200 S COURTHOUSE RD APT 127
ARLINGTON VA
22204-6258
US

V. Phone/Fax

Practice location:
  • Phone: 703-826-9551
  • Fax:
Mailing address:
  • Phone: 703-826-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. NKECHI EKE
Title or Position: RN
Credential:
Phone: 682-227-9815