Healthcare Provider Details

I. General information

NPI: 1487212361
Provider Name (Legal Business Name): HIS & HERS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 MAIN ST STE 700
FAIRFAX VA
22030-4729
US

IV. Provider business mailing address

10805 MAIN ST STE 700
FAIRFAX VA
22030-4729
US

V. Phone/Fax

Practice location:
  • Phone: 571-309-7460
  • Fax: 703-842-6172
Mailing address:
  • Phone: 571-309-7460
  • Fax: 703-842-6172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MUNIRA AIEN HANAFFI
Title or Position: OWNER
Credential:
Phone: 571-309-7460