Provider Demographics
NPI:1518300938
Name:ISADA HEALTHCARE SERVICES, INC.
Entity Type:Organization
Organization Name:ISADA HEALTHCARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, MSN, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-665-4479
Mailing Address - Street 1:4355 RIDGEWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5308
Mailing Address - Country:US
Mailing Address - Phone:703-665-4479
Mailing Address - Fax:703-940-1116
Practice Address - Street 1:4355 RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5308
Practice Address - Country:US
Practice Address - Phone:703-665-4479
Practice Address - Fax:703-940-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC2100X, 3747P1801X, 385H00000X
VAHCO-13947251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-13947OtherOFFICE OF LINCENSURE AND CERTIFICATION