Provider Demographics
NPI:1407377682
Name:KISSINGER HEALTHCARE ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KISSINGER HEALTHCARE ENTERPRISES, LLC
Other - Org Name:HOMEWATCH CAREGIVERS OF FAIRFAX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER & ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, JD, LLM
Authorized Official - Phone:703-992-7420
Mailing Address - Street 1:3921 OLD LEE HWY STE 71C
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2429
Mailing Address - Country:US
Mailing Address - Phone:703-992-7420
Mailing Address - Fax:703-992-7402
Practice Address - Street 1:3921 OLD LEE HWY STE 71C
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2429
Practice Address - Country:US
Practice Address - Phone:703-992-7420
Practice Address - Fax:703-992-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 372600000X
VAHCO-176223747P1801X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty