Healthcare Provider Details

I. General information

NPI: 1255117982
Provider Name (Legal Business Name): TAJ HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21751 LADYSLIPPER SQ
ASHBURN VA
20147-6952
US

IV. Provider business mailing address

21751 LADYSLIPPER SQ
ASHBURN VA
20147-6952
US

V. Phone/Fax

Practice location:
  • Phone: 571-315-4519
  • Fax:
Mailing address:
  • Phone: 571-315-4519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: IRUM IFTIKHAR
Title or Position: PRESIDENT
Credential:
Phone: 571-525-8469