Healthcare Provider Details

I. General information

NPI: 1639913643
Provider Name (Legal Business Name): HEAVENLY TOUCH HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9681 MAIN ST STE C
FAIRFAX VA
22031-3769
US

IV. Provider business mailing address

9681 MAIN ST STE C
FAIRFAX VA
22031-3769
US

V. Phone/Fax

Practice location:
  • Phone: 703-395-9854
  • Fax:
Mailing address:
  • Phone: 703-395-9854
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. FAISA ALI
Title or Position: OWNER
Credential:
Phone: 571-407-7194