Healthcare Provider Details

I. General information

NPI: 1154168680
Provider Name (Legal Business Name): AMANA HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 UNIVERSITY DR STE 300
FAIRFAX VA
22030-2513
US

IV. Provider business mailing address

3900 UNIVERSITY DR STE 300
FAIRFAX VA
22030-2513
US

V. Phone/Fax

Practice location:
  • Phone: 703-831-7747
  • Fax: 703-573-4262
Mailing address:
  • Phone: 703-831-7747
  • Fax: 703-573-4262

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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KIFAYA ABUBEKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-831-7747