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General NPI Number Information
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NPI Number | 1912396458
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Entity Type | Organization
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Legal Business Name | GREEN HOME CARE AGENCY, LLC
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Dates
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Enumeration Date | 01/21/2015
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Last Update Date | 01/21/2015
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Provider Practice Location Address
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Address Line | 2562 MIRANDA CT
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5175
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Country | US
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Telephone | 703-439-7382
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Fax |
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Provider Business Mailing Address
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Address Line | 2562 MIRANDA CT
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City | WOODBRIDGE
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State | VA
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Zip | 22191-5175
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Country | US
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Telephone | 703-439-7382
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Fax |
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Authorized Official
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Title or Position | FOUNDER/CEO
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Name | MS. KHALIDAH A SEDIQ
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Credential |
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Telephone | 703-439-7382
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 372600000X
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License Number State | VA
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