Healthcare Provider Details

I. General information

NPI: 1184536138
Provider Name (Legal Business Name): HOUSE OF DERIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

IV. Provider business mailing address

10432 BALLS FORD RD STE 300
MANASSAS VA
20109-2517
US

V. Phone/Fax

Practice location:
  • Phone: 571-600-6301
  • Fax: 571-667-6381
Mailing address:
  • Phone: 571-600-6301
  • Fax: 571-667-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ABIDEMI AJOKE OLUWABIYI
Title or Position: MANAGING MEMBER
Credential: CNA
Phone: 571-501-0926