Pan Homehealth Support Services LLC

NPI #1104500123 in Annandale, Virginia

Provider Information

NPI Number: 1104500123
Entity Type: Organization
Organization Name: Pan Homehealth Support Services LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jun 12, 2023
Last Updated: Jun 12, 2023

Practice Location

Address: 4201 JOHN MARR DR STE 210
City: Annandale
State: Virginia
ZIP Code: 22003-3204
Phone: (301) 437-7749

Authorized Official

Name: CLETUS A FONMEDIG, DDS
Title: DIRECTOR
Phone: (301) 437-7749

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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