Healthcare Provider Details

I. General information

NPI: 1356592620
Provider Name (Legal Business Name): FICUS HOME HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21767 LADYSLIPPER SQ
ASHBURN VA
20147-6952
US

IV. Provider business mailing address

21767 LADYSLIPPER SQ
ASHBURN VA
20147-6952
US

V. Phone/Fax

Practice location:
  • Phone: 302-229-5814
  • Fax:
Mailing address:
  • Phone:
  • 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: MOLINA MATHUR
Title or Position: OWNER
Credential:
Phone: 302-229-5814