Provider Demographics
NPI:1376346635
Name:MEMORIES OF LIFE HOME CARE LLC
Entity type:Organization
Organization Name:MEMORIES OF LIFE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOYCELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-DANKWAA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-296-8864
Mailing Address - Street 1:2625 CAST OFF LOOP
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-1470
Mailing Address - Country:US
Mailing Address - Phone:703-296-8864
Mailing Address - Fax:
Practice Address - Street 1:800 CORPORATE DR STE 343
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4889
Practice Address - Country:US
Practice Address - Phone:703-296-8864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health