=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407337058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHARCO HEALTH SOLUTION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2018
-----------------------------------------------------
Last Update Date | 08/22/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10013 MOXLEYS FORD LN
-----------------------------------------------------
City | BRISTOW
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20136-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-369-1404
-----------------------------------------------------
Fax | 703-369-3136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10013 MOXLEYS FORD LN
-----------------------------------------------------
City | BRISTOW
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20136-3004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-369-1404
-----------------------------------------------------
Fax | 703-369-3136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RN BSN / ADMINISTRATION/DON
-----------------------------------------------------
Name | CHARLOTTE AMOAKO-ATTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-369-1404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------