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General NPI Number Information
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NPI Number | 1518630748
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Entity Type | Organization
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Legal Business Name | HOLISTIC CARE SERVICES, LLC
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Dates
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Enumeration Date | 07/25/2021
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Last Update Date | 07/25/2021
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Provider Practice Location Address
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Address Line | 9020F LORTON STATION BLVD STE 115
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City | LORTON
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State | VA
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Zip | 22079-4799
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Country | US
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Telephone | 703-744-0673
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Fax |
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Provider Business Mailing Address
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Address Line | 40 HULVEY DR
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City | STAFFORD
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State | VA
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Zip | 22556-3816
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Country | US
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Telephone | 540-735-4315
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Fax |
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Authorized Official
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Title or Position | CEO/PROGRAM DIRECTOR
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Name | FATMATA BANGURA
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Credential |
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Telephone | 703-744-0673
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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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