Provider Demographics
NPI:1073197604
Name:STALWART HOME HEALTH LLC
Entity Type:Organization
Organization Name:STALWART HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-346-3640
Mailing Address - Street 1:2004 PIN OAK PKWY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3098
Mailing Address - Country:US
Mailing Address - Phone:301-346-3640
Mailing Address - Fax:
Practice Address - Street 1:13000 HARBOR CENTER DR # 312M
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2846
Practice Address - Country:US
Practice Address - Phone:571-466-8794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2021OtherSTATE CORP