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General NPI Number Information
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NPI Number | 1902273188
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Entity Type | Organization
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Legal Business Name | BETHESDACARE-HOUSEOFMERCY,LLC
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 11 JOSHUA RD
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City | STAFFORD
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State | VA
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Zip | 22556-3608
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Country | US
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Telephone | 540-318-0484
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Fax | 703-337-0331
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Provider Business Mailing Address
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Address Line | PO BOX 22
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City | STAFFORD
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State | VA
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Zip | 22555-0022
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Country | US
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Telephone | 540-318-0484
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Fax | 703-337-0331
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. NABUNYI HONORINE MWAMIZINZI
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Credential | BS
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Telephone | 703-867-2141
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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 | HCO161329
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License Number State | VA
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