Provider Demographics
NPI:1891800298
Name:PURE HEART HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:PURE HEART HEALTH SERVICES, LLC
Other - Org Name:PURE HEART CARE PROVIDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSEI WUSU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-310-7062
Mailing Address - Street 1:211 N UNION ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2657
Mailing Address - Country:US
Mailing Address - Phone:703-310-7062
Mailing Address - Fax:877-768-5149
Practice Address - Street 1:211 N UNION ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2657
Practice Address - Country:US
Practice Address - Phone:703-310-7062
Practice Address - Fax:877-768-5149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARESPITE CAREOtherRESPITE CARE
VAPERSONAL CAREOtherPERSONAL CARE