Healthcare Provider Details

I. General information

NPI: 1609897586
Provider Name (Legal Business Name): KENOLY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 ARLINGTON BLVD SUITE 210
FAIRFAX VA
22031-2903
US

IV. Provider business mailing address

8303 ARLINGTON BLVD SUITE 210
FAIRFAX VA
22031-2903
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-3852
  • Fax: 703-573-3853
Mailing address:
  • Phone: 703-573-3852
  • Fax: 703-573-3853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO 264
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO264
License Number StateVA

VIII. Authorized Official

Name: MS. KEKELWA NOLIYA DALL
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 703-573-3852