Provider Demographics
NPI:1336453208
Name:MA-LOWE HOME CARE AGENCY MANASSAS, INC
Entity Type:Organization
Organization Name:MA-LOWE HOME CARE AGENCY MANASSAS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:703-392-4240
Mailing Address - Street 1:8811 SUDLEY RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4750
Mailing Address - Country:US
Mailing Address - Phone:703-392-4240
Mailing Address - Fax:703-392-4243
Practice Address - Street 1:8811 SUDLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4750
Practice Address - Country:US
Practice Address - Phone:703-392-4240
Practice Address - Fax:703-392-4243
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MA-LOWE HOME CARE AGENCY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-11550251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0154717430Medicaid
VA0154926437Medicaid