Healthcare Provider Details

I. General information

NPI: 1720711575
Provider Name (Legal Business Name): CHARIS GRACE HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 600
FAIRFAX VA
22031-4516
US

IV. Provider business mailing address

8280 WILLOW OAKS CORPORATE DR STE 600
FAIRFAX VA
22031-4516
US

V. Phone/Fax

Practice location:
  • Phone: 571-575-4867
  • Fax:
Mailing address:
  • Phone: 703-589-9167
  • 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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HILDA KAETU-SMITH
Title or Position: ADMINISTATOR, DIRECTOR
Credential:
Phone: 703-589-9167