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General NPI Number Information
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NPI Number | 1639671472
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Entity Type | Organization
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Legal Business Name | GIFTED TOUCH HOMEHEALTH
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 11350 RANDOM HILLS RD STE 800
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City | FAIRFAX
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State | VA
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Zip | 22030-6044
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Country | US
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Telephone | 571-215-1704
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Fax |
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Provider Business Mailing Address
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Address Line | 3977 BURNING BUSH CT
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City | FAIRFAX
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State | VA
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Zip | 22033-2447
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Country | US
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Telephone | 571-215-1704
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Fax |
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Authorized Official
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Title or Position | CEO/ADMINISTARTOR
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Name | SECRET MADAWO
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Credential | RN
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Telephone | 571-215-1704
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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 | HCO-1770
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License Number State | VA
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