Provider Demographics
NPI:1982078010
Name:GHODOUSI LLC
Entity type:Organization
Organization Name:GHODOUSI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODOUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-224-8985
Mailing Address - Street 1:2331 MILL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4677
Mailing Address - Country:US
Mailing Address - Phone:571-297-4756
Mailing Address - Fax:
Practice Address - Street 1:5702 GENERAL WASHINGTON DR
Practice Address - Street 2:SUITE G
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2409
Practice Address - Country:US
Practice Address - Phone:703-224-8985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15-GTEC332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment