Healthcare Provider Details

I. General information

NPI: 1801600523
Provider Name (Legal Business Name): YOUSSEF DJEBBARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 SUDLEY RD STE 376
MANASSAS VA
20109-2886
US

IV. Provider business mailing address

7900 SUDLEY RD STE 376
MANASSAS VA
20109-2886
US

V. Phone/Fax

Practice location:
  • Phone: 703-568-2559
  • Fax: 855-853-6635
Mailing address:
  • Phone: 703-568-2559
  • Fax: 855-853-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-005691
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-005691
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberHCO-005691
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHCO-005691
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License NumberHCO-005691
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHCO-005691
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: