Provider Demographics
NPI:1801466834
Name:KMA HEALTH SERVICES VA, INC.
Entity type:Organization
Organization Name:KMA HEALTH SERVICES VA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELEHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-558-8804
Mailing Address - Street 1:10560 MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7177
Mailing Address - Country:US
Mailing Address - Phone:202-558-8804
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7177
Practice Address - Country:US
Practice Address - Phone:202-558-8804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-30
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities