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General NPI Number Information
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NPI Number | 1962196014
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Entity Type | Organization
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Legal Business Name | IN-HOME SUPPORTIVE SERVICE
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Dates
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Enumeration Date | 06/02/2023
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 3526 NEXUS CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4437
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Country | US
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Telephone | 510-677-8671
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Fax |
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Provider Business Mailing Address
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Address Line | 3526 NEXUS CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4437
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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 | LIDA NAB
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Credential |
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Telephone | 510-677-8671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #2
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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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