Healthcare Provider Details

I. General information

NPI: 1043187495
Provider Name (Legal Business Name): MENA HOME HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12953 RIDGEMIST LN
FAIRFAX VA
22033-2118
US

IV. Provider business mailing address

12953 RIDGEMIST LN
FAIRFAX VA
22033-2118
US

V. Phone/Fax

Practice location:
  • Phone: 571-278-5170
  • Fax:
Mailing address:
  • Phone: 571-278-5170
  • 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 Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HODAN HASSAN
Title or Position: OWNER
Credential:
Phone: 703-655-8720