Provider Demographics
NPI:1518630748
Name:HOLISTIC CARE SERVICES, LLC
Entity Type:Organization
Organization Name:HOLISTIC CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FATMATA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-744-0673
Mailing Address - Street 1:40 HULVEY DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-3816
Mailing Address - Country:US
Mailing Address - Phone:540-735-4315
Mailing Address - Fax:
Practice Address - Street 1:9020F LORTON STATION BLVD STE 115
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4799
Practice Address - Country:US
Practice Address - Phone:703-744-0673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0920595375Medicaid