=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154077550
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLEGIANCE HEALTHCARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2022
-----------------------------------------------------
Last Update Date | 12/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4020 MIDDLETON LOOP APT 204
-----------------------------------------------------
City | DUMFRIES
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22025-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-232-4999
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4020 MIDDLETON LOOP APT 204
-----------------------------------------------------
City | MONTCLAIR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22025-2111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-232-5239
-----------------------------------------------------
Fax | 703-665-3121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | EUNICE MUFUSHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-232-5239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------