Provider Demographics
NPI:1639671472
Name:GIFTED TOUCH HOMEHEALTH
Entity Type:Organization
Organization Name:GIFTED TOUCH HOMEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTARTOR
Authorized Official - Prefix:
Authorized Official - First Name:SECRET
Authorized Official - Middle Name:
Authorized Official - Last Name:MADAWO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:571-215-1704
Mailing Address - Street 1:3977 BURNING BUSH CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2447
Mailing Address - Country:US
Mailing Address - Phone:571-215-1704
Mailing Address - Fax:
Practice Address - Street 1:11350 RANDOM HILLS RD STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6044
Practice Address - Country:US
Practice Address - Phone:571-215-1704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-1770251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health