=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396197778
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VJL HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2016
-----------------------------------------------------
Last Update Date | 09/01/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 AUTUMN LEAF DR
-----------------------------------------------------
City | MARTINSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25401-2990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-734-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14013 WESTVIEW FOREST DR
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20720-4867
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-734-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MR. JOSEPH TEKERA TEZI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-734-1944
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------