Provider Demographics
NPI:1043084791
Name:VA OPEN HEALTH CARE
Entity Type:Organization
Organization Name:VA OPEN HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-278-8811
Mailing Address - Street 1:4216 EVERGREEN LN STE 135
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3256
Mailing Address - Country:US
Mailing Address - Phone:703-268-0107
Mailing Address - Fax:
Practice Address - Street 1:4216 EVERGREEN LN STE 135
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3256
Practice Address - Country:US
Practice Address - Phone:703-268-0107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care