Provider Demographics
NPI:1811748775
Name:LEKSTRA SUPPORT RESIDENTIAL SERVICES LLC
Entity type:Organization
Organization Name:LEKSTRA SUPPORT RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORFAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-564-8143
Mailing Address - Street 1:2750 GREEN ASH LOOP APT 207
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4162
Mailing Address - Country:US
Mailing Address - Phone:240-564-8143
Mailing Address - Fax:
Practice Address - Street 1:2750 GREEN ASH LOOP APT 207
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4162
Practice Address - Country:US
Practice Address - Phone:240-564-8143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care