Healthcare Provider Details

I. General information

NPI: 1568977593
Provider Name (Legal Business Name): MPS HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 OLD MEADOW RD STE 600
MC LEAN VA
22102-4389
US

IV. Provider business mailing address

1651 OLD MEADOW RD STE 600
MC LEAN VA
22102-4389
US

V. Phone/Fax

Practice location:
  • Phone: 703-506-0123
  • Fax: 703-734-1932
Mailing address:
  • Phone: 703-506-0123
  • Fax: 703-734-1932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001142058
License Number StateVA

VIII. Authorized Official

Name: MRS. KATHERINE MITCHELL
Title or Position: NATIONAL DIRECTOR OF NURSING
Credential: RN
Phone: 703-506-0123