Provider Demographics
NPI:1639482318
Name:STANDARD HEALTHCARE SERVICES, INC
Entity Type:Organization
Organization Name:STANDARD HEALTHCARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ISIBOR
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:NOSEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-675-7720
Mailing Address - Street 1:20942 DURYEA TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6494
Mailing Address - Country:US
Mailing Address - Phone:703-675-7720
Mailing Address - Fax:703-891-1789
Practice Address - Street 1:1073 W BROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4612
Practice Address - Country:US
Practice Address - Phone:703-676-7720
Practice Address - Fax:703-891-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-10252251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101623863Medicaid
VAHCO-10252OtherVIRGINIA DEPARTMENT OF HEALTH