Provider Demographics
NPI:1497295554
Name:PASSION HOME CARE LLC
Entity Type:Organization
Organization Name:PASSION HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KADIATU
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-991-1802
Mailing Address - Street 1:2109 CALLAO CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1480
Mailing Address - Country:US
Mailing Address - Phone:571-991-1802
Mailing Address - Fax:
Practice Address - Street 1:2109 CALLAO CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-1480
Practice Address - Country:US
Practice Address - Phone:571-991-1802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health