Healthcare Provider Details

I. General information

NPI: 1790299337
Provider Name (Legal Business Name): DAILY DOSE NURSING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

IV. Provider business mailing address

4330 RIDGEWOOD CENTER DR
WOODBRIDGE VA
22192-5307
US

V. Phone/Fax

Practice location:
  • Phone: 571-298-3392
  • Fax:
Mailing address:
  • Phone: 571-298-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHCO-181328
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCO-181328
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberHCO-181328
License Number StateVA

VIII. Authorized Official

Name: MR. KOUADIO KRA KOKO
Title or Position: ADMINISTRATOR
Credential: REGISTERED NURSE
Phone: 703-843-6603