Healthcare Provider Details

I. General information

NPI: 1780185884
Provider Name (Legal Business Name): PROCEDA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44043 FERNCLIFF TER
ASHBURN VA
20147-3329
US

IV. Provider business mailing address

PO BOX 2182
ASHBURN VA
20146-9082
US

V. Phone/Fax

Practice location:
  • Phone: 240-343-3105
  • 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
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KOKOE EZUI
Title or Position: EXECUTIVE DIRECTOR
Credential: MPH, LPN
Phone: 571-598-4008