MEDICARE: 1ST ADULT N PEDIATRIC HEALTHCARE SERVICES 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
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1912356098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST ADULT N PEDIATRIC HEALTHCARE SERVICES INC

Provider Business Mailing Address
First Line	:	731 SEATON AVE UNIT 339
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-3063
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 SEATON AVE UNIT 339
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22305-3063
Country	:	US
Telephone Number	:	703-362-7277
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTATOR
Name	:	SHEKITA GORE
Credential	:
Telephone Number	:	703-362-7277

Provider Enumeration Date	:	06/08/2016
Last Update Date	:	07/21/2016

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