=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922278282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHEKINAH CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2008
-----------------------------------------------------
Last Update Date | 05/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2213 DILORETA DRIVE
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-869-8849
-----------------------------------------------------
Fax | 703-491-5357
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2213 DILORETA DRIVE
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-869-8849
-----------------------------------------------------
Fax | 703-491-5357
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | MISS JOYCE OWUSU BEMPAH
-----------------------------------------------------
Credential | CEO
-----------------------------------------------------
Telephone | 703-869-8849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------