Provider Demographics
NPI:1811721418
Name:VITAL LIGHT HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:VITAL LIGHT HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEQA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-483-1912
Mailing Address - Street 1:4185 BROOKGREEN DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-6207
Mailing Address - Country:US
Mailing Address - Phone:703-483-1912
Mailing Address - Fax:
Practice Address - Street 1:6654 HIGH VALLEY LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5007
Practice Address - Country:US
Practice Address - Phone:703-483-1912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health