Provider Demographics
NPI:1598203457
Name:BEDKNOBS AND BROOMSTIX HOMECARE
Entity Type:Organization
Organization Name:BEDKNOBS AND BROOMSTIX HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-583-3561
Mailing Address - Street 1:5868 MAPLEDALE PLZ
Mailing Address - Street 2:#106
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4535
Mailing Address - Country:US
Mailing Address - Phone:703-583-3561
Mailing Address - Fax:855-332-8585
Practice Address - Street 1:12836 GLEN FOREST CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20112-8872
Practice Address - Country:US
Practice Address - Phone:703-583-3561
Practice Address - Fax:855-332-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2OtherHOMECARE