MEDICARE: MULBERRY LIFE HOME HEALTH CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174475891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULBERRY LIFE HOME HEALTH CARE SERVICES

Provider Business Mailing Address
First Line	:	70 SOUTHPARK MALL
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2962
Country	:	US
Telephone Number	:	267-596-6607
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 SOUTHPARK MALL
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2962
Country	:	US
Telephone Number	:	267-596-6607
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WALI ABDUL COOPER
Credential	:
Telephone Number	:	267-596-6607

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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