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General NPI Number Information
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NPI Number | 1750613113
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Entity Type | Organization
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Legal Business Name | SECURED HOME HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/09/2010
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Last Update Date | 02/09/2010
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Provider Practice Location Address
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Address Line | 9401 MATHY DR SUITE 300
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City | FAIRFAX
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State | VA
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Zip | 22031-5310
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Country | US
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Telephone | 703-268-5910
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Fax | 703-539-8350
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Provider Business Mailing Address
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Address Line | 9401 MATHY DR SUITE 300
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City | FAIRFAX
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State | VA
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Zip | 22031-5310
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Country | US
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Telephone | 703-268-5910
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Fax | 703-539-8350
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Authorized Official
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Title or Position | ADMINISTRATOR / DIRECTOR OF NURSING
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Name | MS. GLADYS AJUBESE NJEM
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Credential | REGISTERED NURSE
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Telephone | 703-928-4226
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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 | HCO10630
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License Number State | VA
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