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General NPI Number Information
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NPI Number | 1639685001
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Entity Type | Organization
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Legal Business Name | QUALIS HOME HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 07/04/2021
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Provider Practice Location Address
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Address Line | 1810 REDDY DR # 5370
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3410
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Country | US
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Telephone | 800-296-3458
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Fax |
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Provider Business Mailing Address
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Address Line | 1810 REDDY DR # 5370
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3410
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | DR. ZAKEVIA DENISE GREEN
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Credential |
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Telephone | 800-296-3458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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