Provider Demographics
NPI: | 1295249688 |
---|---|
Name: | PROVEN HEALTHCARE RESOURCES INC. |
Entity type: | Organization |
Organization Name: | PROVEN HEALTHCARE RESOURCES INC. |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO/ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | OLAYINKA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FOLAYAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 703-344-8217 |
Mailing Address - Street 1: | 8201 EUCLID CT STE 201E |
Mailing Address - Street 2: | |
Mailing Address - City: | MANASSAS PARK |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 20111-4835 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 8201 EUCLID CT STE 201E |
Practice Address - Street 2: | |
Practice Address - City: | MANASSAS PARK |
Practice Address - State: | VA |
Practice Address - Zip Code: | 20111-4835 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-344-8217 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2017-11-22 |
Last Update Date: | 2017-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty |