MEDICARE: LIFE ENRICHMENT HOME CARE, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1932894250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE ENRICHMENT HOME CARE, LLC

Provider Business Mailing Address
First Line	:	5613 LEESBURG PIKE STE 23
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2909
Country	:	US
Telephone Number	:	614-563-3402
Fax Number	:

Provider Business Practice Location Address
First Line	:	5613 LEESBURG PIKE STE 23
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22041-2909
Country	:	US
Telephone Number	:	614-563-3402
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SADIA ABDI
Credential	:
Telephone Number	:	614-563-3402

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	04/11/2023

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