Provider Demographics
NPI:1447863709
Name:FONGE HOME HEALTH SERVICES,LLC
Entity type:Organization
Organization Name:FONGE HOME HEALTH SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BINETTE
Authorized Official - Middle Name:FORZONG
Authorized Official - Last Name:FONGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-390-7313
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR STE 1300G
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1261
Mailing Address - Country:US
Mailing Address - Phone:120-275-8420
Mailing Address - Fax:
Practice Address - Street 1:4229 LAFAYETTE CENTER DR STE 1300G
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:120-275-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health