Healthcare Provider Details

I. General information

NPI: 1972238673
Provider Name (Legal Business Name): M.A.K. SUPERIOR HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2022
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13601 OFFICE PL STE 102A
WOODBRIDGE VA
22192-4213
US

IV. Provider business mailing address

13601 OFFICE PL STE 102A
WOODBRIDGE VA
22192-4213
US

V. Phone/Fax

Practice location:
  • Phone: 804-807-9104
  • Fax: 571-520-0356
Mailing address:
  • Phone: 804-807-9104
  • Fax: 571-520-0356

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MED FRANCES TAQI
Title or Position: CO-CEO/ADMINISTRATOR
Credential:
Phone: 571-354-5365