Healthcare Provider Details

I. General information

NPI: 1972959591
Provider Name (Legal Business Name): R & J HOME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14798 BUILD AMERICA DR
WOODBRIDGE VA
22191-3435
US

IV. Provider business mailing address

14798 BUILD AMERICA DR
WOODBRIDGE VA
22191-3435
US

V. Phone/Fax

Practice location:
  • Phone: 571-477-3406
  • Fax:
Mailing address:
  • Phone: 571-477-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number161414
License Number StateVA

VIII. Authorized Official

Name: RITA AMPOMAH
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-494-1100