=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720548068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SBIHI HOSPITALITY GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4100 MONUMENT CORNER DR STE 400B
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-8610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-718-5455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13347 CONNOR DR APT F
-----------------------------------------------------
City | CENTREVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20120-3047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-577-6771
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | MR. MOHAMED SBIHI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-577-6771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------