Provider Demographics
NPI:1407097454
Name:BAK HOME HEALTHCARE SERVICE
Entity Type:Organization
Organization Name:BAK HOME HEALTHCARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE TECH
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKARE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:703-338-3654
Mailing Address - Street 1:4160 PINEYRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1841
Mailing Address - Country:US
Mailing Address - Phone:703-338-3654
Mailing Address - Fax:703-730-5391
Practice Address - Street 1:4160 PINEYRIDGE LN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1841
Practice Address - Country:US
Practice Address - Phone:703-338-3654
Practice Address - Fax:703-730-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06L23950251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health