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General NPI Number Information
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NPI Number | 1497407522
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Entity Type | Organization
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Legal Business Name | IBWII GROUP LLC
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 22648 GLENN DR SUITE 304
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City | STERLING
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State | VA
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Zip | 20164-2016
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Country | US
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Telephone | 571-732-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 22648 GLENN DR SUITE 304
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City | STERLING
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State | VA
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Zip | 20164
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Country | US
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Telephone | 571-732-6800
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TYRONE OSILESI
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Credential | CSA
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Telephone | 571-732-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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