=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093038457
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPAT CERTIFIED IN-HOME NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2010
-----------------------------------------------------
Last Update Date | 03/12/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17932 FRALEY BLVD STE 400A
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22026-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-221-1288
-----------------------------------------------------
Fax | 703-997-0063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17932 FRALEY BLVD STE 400A
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22026-2485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-221-1288
-----------------------------------------------------
Fax | 703-997-0063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINIDTRATOR
-----------------------------------------------------
Name | COMFORT OWUSU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 571-276-2100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------