Organization
IN-HOME SUPPORTIVE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIDA NAB (OWNER)
(510) 677-8671
Entity
Organization
Contact information
Practice address
3526 NEXUS CT, WOODBRIDGE, VA 22192-4437
(510) 677-8671
Mailing address
3526 NEXUS CT, WOODBRIDGE, VA 22192-4437
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
06/02/2023
Last updated
01/16/2025
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