Healthcare Provider Details

I. General information

NPI: 1437501244
Provider Name (Legal Business Name): SEBA PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 BALLS FORD RD SUITE 300
MANASSAS VA
20109-2514
US

IV. Provider business mailing address

10432 BALLS FORD RD SUITE 300
MANASSAS VA
20109-2514
US

V. Phone/Fax

Practice location:
  • Phone: 703-856-2078
  • Fax:
Mailing address:
  • Phone: 703-856-2078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERHIUVIE ABU
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 703-856-2078