Healthcare Provider Details

I. General information

NPI: 1871295949
Provider Name (Legal Business Name): AGING IN PLACE CAREGIVING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6223 GLEN WOOD LOOP
MANASSAS VA
20112-8871
US

IV. Provider business mailing address

15000 POTOMAC TOWN PL STE 100-147
WOODBRIDGE VA
22191-6586
US

V. Phone/Fax

Practice location:
  • Phone: 571-762-0189
  • Fax:
Mailing address:
  • Phone: 734-218-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. FONYA C ATABONG
Title or Position: DIRECTOR OF NURSING
Credential: DNP
Phone: 734-218-5001