Healthcare Provider Details

I. General information

NPI: 1285513341
Provider Name (Legal Business Name): 634 LIVING CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 POTOMAC TOWN PL STE 100-512
WOODBRIDGE VA
22191-6586
US

IV. Provider business mailing address

15000 POTOMAC TOWN PL STE 100-512
WOODBRIDGE VA
22191-6586
US

V. Phone/Fax

Practice location:
  • Phone: 571-932-3266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: NIESHA ANDERSON
Title or Position: CEO
Credential:
Phone: 571-932-3266