Provider Demographics
NPI:1356854608
Name:ANCIENT HEALING HEALTHCARE SERVICES,LLC
Entity Type:Organization
Organization Name:ANCIENT HEALING HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADON
Authorized Official - Prefix:
Authorized Official - First Name:REHEMA
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:MOLLEL
Authorized Official - Suffix:
Authorized Official - Credentials:ADON
Authorized Official - Phone:703-647-3645
Mailing Address - Street 1:5680 KING CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5757
Mailing Address - Country:US
Mailing Address - Phone:703-647-3645
Mailing Address - Fax:
Practice Address - Street 1:5680 KING CENTRE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5757
Practice Address - Country:US
Practice Address - Phone:703-647-3645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-1754251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health