# MINERVA HOME HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164821484
- **Authorized official:** MISS SHADE GREEN BSN (DON)
- **Authorized official phone:** (240) 603-5025

## Contact information

- **Practice address:** 1310 VINCENT PL STE B, MC LEAN, VA 22101-3614
- **Practice address phone:** (240) 603-5025
- **Practice address fax:** (855) 639-0043
- **Mailing address:** 1310 VINCENT PL STE B, MC LEAN, VA 22101-3614
- **Mailing address phone:** (240) 603-5025
- **Mailing address fax:** (855) 639-0043

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 151193 | VA | Yes |

## Other

- **Enumeration date:** 08/22/2014
- **Last updated:** 03/06/2024