Pan Homehealth Support Services LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

PAN HOMEHEALTH SUPPORT SERVICES LLC

Practice address

4201 John Marr Dr Ste 210
Annandale, VA 22003-3204

Phone

(301) 437-7749

NPI assigned

Jun 12, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Cletus A Fonmedig, DDSNPI 1518129998

Title

Director

Phone

(301) 437-7749

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Cletus Fonmedig, DDS

  • General Practice Dentistry
  • Rosedale, MD
  • NPI 1518129998
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1104500123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 JOHN MARR DR STE 210",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033204",
            "telephone_number": "301-437-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 JOHN MARR DR STE 210",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220033204",
            "telephone_number": "301-437-7749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAN HOMEHEALTH SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-12",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-10",
        "status": "A",
        "authorized_official_last_name": "FONMEDIG",
        "authorized_official_first_name": "CLETUS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "301-437-7749",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blessing Owusu, LPN
• Deborah Yvonne Pacheco, M.D.
• Seung W Paik, M.D.
• Gopal S Pal, D.D.S.
• Sandhya A Pal, D.D.S.
• Manisha Parikh, P.T.
• Ah Reum Park
• Henry Insuk Park, DDS
• Hune June Park, DMD
• Jaung Soon Park, L.AC., DAOM

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Annandale, VA
• Providers in Annandale, VA by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.