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General NPI Number Information
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NPI Number | 1407097454
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Entity Type | Organization
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Legal Business Name | BAK HOME HEALTHCARE SERVICE
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 4160 PINEYRIDGE LN
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1841
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Country | US
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Telephone | 703-338-3654
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Fax | 703-730-5391
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Provider Business Mailing Address
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Address Line | 4160 PINEYRIDGE LN
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City | WOODBRIDGE
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State | VA
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Zip | 22193-1841
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Country | US
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Telephone | 703-338-3654
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Fax | 703-730-5391
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Authorized Official
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Title or Position | NURSE TECH
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Name | MARIE BAKARE
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Credential | ADMINISTRATOR
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Telephone | 703-338-3654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 06L23950
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License Number State | VA
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