Provider Demographics
NPI:1669949905
Name:DESIRED LIVING HOME CARE LLC
Entity type:Organization
Organization Name:DESIRED LIVING HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALAMATU
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:571-225-9860
Mailing Address - Street 1:2349 BATTERY HILL CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6515
Mailing Address - Country:US
Mailing Address - Phone:571-225-9860
Mailing Address - Fax:540-388-4647
Practice Address - Street 1:2349 BATTERY HILL CIR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6515
Practice Address - Country:US
Practice Address - Phone:571-225-9860
Practice Address - Fax:540-388-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251E00000XAgenciesHome Health