MEDICARE: GOOD HOPE HOME HEALTHCARE LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1235772716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HOPE HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	12020 SUNRISE VALLEY DR STE 139
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3440
Country	:	US
Telephone Number	:	469-988-0942
Fax Number	:

Provider Business Practice Location Address
First Line	:	12020 SUNRISE VALLEY DR STE 139
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3440
Country	:	US
Telephone Number	:	469-988-0942
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TATIANA NDEKE
Credential	:
Telephone Number	:	469-988-0942

Provider Enumeration Date	:	10/28/2019
Last Update Date	:	10/28/2019

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Directions to “GOOD HOPE HOME HEALTHCARE LLC ” Practice Location

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