Healthcare Provider Details

I. General information

NPI: 1992246706
Provider Name (Legal Business Name): THE PASSION HOME HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 CALLAO CT
WOODBRIDGE VA
22191-1480
US

IV. Provider business mailing address

2109 CALLAO CT
WOODBRIDGE VA
22191-1480
US

V. Phone/Fax

Practice location:
  • Phone: 571-991-1802
  • Fax:
Mailing address:
  • Phone: 571-991-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KADIATU FORNAH
Title or Position: OWNER
Credential:
Phone: 571-991-1802