Provider Demographics
NPI:1639843949
Name:ROSA MYSTICA PROFESSIONAL HOME HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:ROSA MYSTICA PROFESSIONAL HOME HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:NKECHI
Authorized Official - Middle Name:
Authorized Official - Last Name:EKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-227-9815
Mailing Address - Street 1:1200 S COURTHOUSE RD APT 127
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-6258
Mailing Address - Country:US
Mailing Address - Phone:703-826-9551
Mailing Address - Fax:
Practice Address - Street 1:1200 S COURTHOUSE RD APT 127
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-6258
Practice Address - Country:US
Practice Address - Phone:703-826-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty