Provider Demographics
NPI:1114279916
Name:PRAISE HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:PRAISE HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PEACE
Authorized Official - Middle Name:
Authorized Official - Last Name:KACHUCHURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-942-6403
Mailing Address - Street 1:3022 JAVIER RD STE 216
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4646
Mailing Address - Country:US
Mailing Address - Phone:703-942-6403
Mailing Address - Fax:703-942-6428
Practice Address - Street 1:3022 JAVIER RD STE 216
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4646
Practice Address - Country:US
Practice Address - Phone:703-942-6403
Practice Address - Fax:703-942-6428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health