Provider Demographics
NPI:1043552599
Name:GREEN VALLEY DME LLC
Entity type:Organization
Organization Name:GREEN VALLEY DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-865-5595
Mailing Address - Street 1:3949 PENDER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6088
Mailing Address - Country:US
Mailing Address - Phone:703-865-5595
Mailing Address - Fax:703-995-4543
Practice Address - Street 1:3957 PENDER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6027
Practice Address - Country:US
Practice Address - Phone:703-865-5595
Practice Address - Fax:703-995-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6904920001Medicare NSC