Provider Demographics
NPI:1245734847
Name:A GIVEN HEART SERVICES INC
Entity Type:Organization
Organization Name:A GIVEN HEART SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GIVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MWALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-354-1504
Mailing Address - Street 1:4012 WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1139
Mailing Address - Country:US
Mailing Address - Phone:571-354-1504
Mailing Address - Fax:703-425-2273
Practice Address - Street 1:4012 WILLIAMSBURG CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1139
Practice Address - Country:US
Practice Address - Phone:571-354-1504
Practice Address - Fax:703-425-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-1813251E00000X
3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid