Healthcare Provider Details

I. General information

NPI: 1720761968
Provider Name (Legal Business Name): FOUR SEASONS HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 07/09/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 SEVEN CORNERS PL STE J
FALLS CHURCH VA
22044-2011
US

IV. Provider business mailing address

6408 SEVEN CORNERS PL STE J
FALLS CHURCH VA
22044-2011
US

V. Phone/Fax

Practice location:
  • Phone: 703-890-2127
  • Fax:
Mailing address:
  • Phone: 703-890-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HIEN TRUONG
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 703-479-6123