Provider Demographics
NPI:1518672880
Name:ENNOBLE HOSPICE VA LLC
Entity Type:Organization
Organization Name:ENNOBLE HOSPICE VA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KUSHABHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-812-9010
Mailing Address - Street 1:2 UNIVERSITY PLZ STE 210
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6211
Mailing Address - Country:US
Mailing Address - Phone:862-812-9010
Mailing Address - Fax:201-208-2927
Practice Address - Street 1:1101 WILSON BLVD STE 957
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2248
Practice Address - Country:US
Practice Address - Phone:703-865-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based