Organization
PAN HOMEHEALTH SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLETUS A FONMEDIG DDS (DIRECTOR)
(301) 437-7749
Entity
Organization
Contact information
Practice address
4201 JOHN MARR DR STE 210, ANNANDALE, VA 22003-3204
(301) 437-7749
Mailing address
4201 JOHN MARR DR STE 210, ANNANDALE, VA 22003-3204
(301) 437-7749
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
06/12/2023
Last updated
06/12/2023
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