Healthcare Provider Details

I. General information

NPI: 1265135545
Provider Name (Legal Business Name): VIGILANT HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20311 BROAD RUN DR
STERLING VA
20165-2513
US

IV. Provider business mailing address

20311 BROAD RUN DR
STERLING VA
20165-2513
US

V. Phone/Fax

Practice location:
  • Phone: 703-963-6160
  • Fax:
Mailing address:
  • Phone: 703-963-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ISMAHAN SALHAN
Title or Position: ADMIN MANAGER
Credential:
Phone: 703-963-6160