Provider Demographics
NPI:1831662667
Name:PARAMOUNT SERENITY HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PARAMOUNT SERENITY HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BINTHA
Authorized Official - Middle Name:FATMATA
Authorized Official - Last Name:KABBA-SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-401-7834
Mailing Address - Street 1:2241H TACKETTS MILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-3029
Mailing Address - Country:US
Mailing Address - Phone:703-494-9019
Mailing Address - Fax:703-494-9109
Practice Address - Street 1:2241H TACKETTS MILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-3029
Practice Address - Country:US
Practice Address - Phone:703-494-9019
Practice Address - Fax:703-494-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-03
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO-2036Medicaid