Healthcare Provider Details

I. General information

NPI: 1639685001
Provider Name (Legal Business Name): QUALIS HOME HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 07/04/2021
Certification Date: 07/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 REDDY DR # 5370
WOODBRIDGE VA
22191-3410
US

IV. Provider business mailing address

1810 REDDY DR # 5370
WOODBRIDGE VA
22191-3410
US

V. Phone/Fax

Practice location:
  • Phone: 800-296-3458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. ZAKEVIA DENISE GREEN
Title or Position: CEO & PRESIDENT
Credential:
Phone: 800-296-3458