Healthcare Provider Details

I. General information

NPI: 1194690255
Provider Name (Legal Business Name): VIRGINIA OPEN SENIOR DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5649 MOUNT GILEAD RD
CENTREVILLE VA
20120-1906
US

IV. Provider business mailing address

8109 LITTLE RIVER TPKE
ANNANDALE VA
22003-2327
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-0910
  • Fax: 571-487-8751
Mailing address:
  • Phone: 703-280-0910
  • Fax: 571-487-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONGHOON KIM
Title or Position: OWNER
Credential: ADULT DAY CARE
Phone: 703-280-0910