Healthcare Provider Details

I. General information

NPI: 1720902273
Provider Name (Legal Business Name): KAEVORA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 ARLA CT
STAFFORD VA
22554-9439
US

IV. Provider business mailing address

133 ARLA CT
STAFFORD VA
22554-9439
US

V. Phone/Fax

Practice location:
  • Phone: 540-429-4223
  • Fax:
Mailing address:
  • Phone: 540-429-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: KADIATU R BANGURA
Title or Position: CEO/ OWNER
Credential:
Phone: 540-429-4223