Healthcare Provider Details

I. General information

NPI: 1407377682
Provider Name (Legal Business Name): KISSINGER HEALTHCARE ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 OLD LEE HWY STE 71C
FAIRFAX VA
22030-2429
US

IV. Provider business mailing address

3921 OLD LEE HWY STE 71C
FAIRFAX VA
22030-2429
US

V. Phone/Fax

Practice location:
  • Phone: 703-992-7420
  • Fax: 703-992-7402
Mailing address:
  • Phone: 703-992-7420
  • Fax: 703-992-7402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHCO-17622
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberHCO-17622
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberHCO-17622
License Number StateVA

VIII. Authorized Official

Name: DONALD KISSINGER
Title or Position: MEMBER & ADMINISTRATOR
Credential: CPA, JD, LL.M.
Phone: 703-992-7420