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General NPI Number Information
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NPI Number | 1760997282
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Entity Type | Organization
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Legal Business Name | MANNERS HEALTH SERVICES CORPORATION
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 614 DECLARATION DR
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City | STAFFORD
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State | VA
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Zip | 22554-8122
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Country | US
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Telephone | 207-409-6232
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Fax |
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Provider Business Mailing Address
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Address Line | 614 DECLARATION DR APT 202
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City | STAFFORD
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State | VA
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Zip | 22554-8123
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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 | OWNER
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Name | MR. JUSTIN MASIRIKA
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Credential |
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Telephone | 207-409-6232
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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 |
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License Number State |
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