Provider Demographics
NPI:1902273188
Name:BETHESDACARE-HOUSEOFMERCY,LLC
Entity Type:Organization
Organization Name:BETHESDACARE-HOUSEOFMERCY,LLC
Other - Org Name:IN HOME CARE AGENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NABUNYI
Authorized Official - Middle Name:HONORINE
Authorized Official - Last Name:MWAMIZINZI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:703-867-2141
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-0022
Mailing Address - Country:US
Mailing Address - Phone:540-318-0484
Mailing Address - Fax:703-337-0331
Practice Address - Street 1:11 JOSHUA RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-3608
Practice Address - Country:US
Practice Address - Phone:540-318-0484
Practice Address - Fax:703-337-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO161329251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health