Provider Demographics
NPI:1306500038
Name:KOROMA, JOSEPHINE (CEO/OWNER)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:KOROMA
Suffix:
Gender:F
Credentials:CEO/OWNER
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:KOROMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HOME HEALTH PROVIDER
Mailing Address - Street 1:13190 CENTERPOINTE WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5286
Mailing Address - Country:US
Mailing Address - Phone:571-774-2345
Mailing Address - Fax:703-490-1211
Practice Address - Street 1:13190 CENTERPOINTE WAY STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5286
Practice Address - Country:US
Practice Address - Phone:571-774-2345
Practice Address - Fax:703-490-1211
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6170320900000X
VAHCO-0003038224Z00000X, 225100000X, 251E00000X, 376K00000X, 374U00000X
VAHCO-233038251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306500038Medicaid