Provider Demographics
NPI:1639333123
Name:REVERENCE AND RESILIENCE DIRECT CARE SERVICES
Entity Type:Organization
Organization Name:REVERENCE AND RESILIENCE DIRECT CARE SERVICES
Other - Org Name:REVERENCEAND RESILIENCE DIRECT CARE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:OPOKU
Authorized Official - Last Name:AGYEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-386-6392
Mailing Address - Street 1:15277 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3911
Mailing Address - Country:US
Mailing Address - Phone:703-349-0963
Mailing Address - Fax:703-441-1789
Practice Address - Street 1:15277 FOREST GROVE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3911
Practice Address - Country:US
Practice Address - Phone:703-349-0963
Practice Address - Fax:703-441-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health