Provider Demographics
NPI:1700644382
Name:MEDVIDA HOME CARE SERVICES
Entity Type:Organization
Organization Name:MEDVIDA HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAKEVIA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-762-6855
Mailing Address - Street 1:4339 RIDGEWOOD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5308
Mailing Address - Country:US
Mailing Address - Phone:703-762-6855
Mailing Address - Fax:
Practice Address - Street 1:4339 RIDGEWOOD CENTER DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5308
Practice Address - Country:US
Practice Address - Phone:703-762-6855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health