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General NPI Number Information
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NPI Number | 1457656084
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Entity Type | Organization
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Legal Business Name | DOMAIN MEDICAL HOME HEALTH & STAFFING, INC.
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 2121 EISENHOWER AVE SUITE 112
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4698
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Country | US
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Telephone | 703-299-4949
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Fax | 703-299-6699
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Provider Business Mailing Address
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Address Line | 2121 EISENHOWER AVE SUITE 112
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4698
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Country | US
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Telephone | 703-299-4949
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Fax | 703-299-6699
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Authorized Official
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Title or Position | CEO
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Name | MR. GIBSON ERHUNMWUNSE
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Credential | CRNP
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Telephone | 703-299-4949
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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 | HC0-11711
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License Number State | VA
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