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NPI Code Detail

MEDICARE: JESUS HEART HOME HEALTH CARE AGENCY, INC.

MEDICARE: JESUS HEART HOME HEALTH CARE AGENCY, INC.
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
1251E00000XHome Health Agency

General Provider Information

NPI Number : 1316325285
Entity Type Code : Organization
Provider Name (Legal Business Name) : JESUS HEART HOME HEALTH CARE AGENCY, INC.
Provider Business Mailing Address
First Line : 8000 TOWERS CRESCENT DR FL 13
Second Line :
City : VIENNA
State : VA
Zip : 22182-6211
Country : US
Telephone Number : 703-760-7845
Fax Number : 703-935-0311
Provider Business Practice Location Address
First Line : 8000 TOWERS CRESCENT DR FL 13
Second Line :
City : VIENNA
State : VA
Zip : 22182-6211
Country : US
Telephone Number : 703-760-7845
Fax Number : 703-935-0311
Authorized Official
Title or Position : OWNER
Name : KABIROU SITOU
Credential :
Telephone Number : 703-760-7845
Provider Enumeration Date : 05/12/2015
Last Update Date : 11/23/2015

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