# IN-HOME SUPPORTIVE SERVICE

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

## Provider details

- **NPI number:** 1962196014
- **Authorized official:** LIDA NAB (OWNER)
- **Authorized official phone:** (510) 677-8671

## Contact information

- **Practice address:** 3526 NEXUS CT, WOODBRIDGE, VA 22192-4437
- **Practice address phone:** (510) 677-8671
- **Mailing address:** 3526 NEXUS CT, WOODBRIDGE, VA 22192-4437

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 3747A0650X | Attendant Care Provider | — | NULL | — |
| 3747A0650X | Attendant Care Provider | — | — | — |

## Other

- **Enumeration date:** 06/02/2023
- **Last updated:** 01/16/2025