Provider Demographics
NPI:1003157579
Name:PRONURSE HOMECARE AND INFUSION
Entity Type:Organization
Organization Name:PRONURSE HOMECARE AND INFUSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:GENUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-591-3930
Mailing Address - Street 1:PO BOX 30453
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-8453
Mailing Address - Country:US
Mailing Address - Phone:703-591-3930
Mailing Address - Fax:703-665-0208
Practice Address - Street 1:6262 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-6262
Practice Address - Country:US
Practice Address - Phone:703-591-3930
Practice Address - Fax:703-665-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-08
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-13936251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-13936OtherHOME CARE ORGANIZATION LICENSE NUMBER
VA49-7711Medicare PIN