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49D2018643 CLIA NUMBER - DOMAIN MEDICAL HOME HEALTH AGENCY AND STAFFING, INC

Laboratory Demographics

CLIA Number: 49D2018643

Facility Name: DOMAIN MEDICAL HOME HEALTH AGENCY AND STAFFING, INC

Facility Address:
2121 EISENHOWER AVENUE - SUITE 200
ALEXANDRIA, VA
ZIP 22314
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Facility Phone Number: 703 518-4333

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1457656084

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 49D2018643
LAB Type Home Health Agency
Facility Name DOMAIN MEDICAL HOME HEALTH AGENCY AND STAFFING, INC
Street 2121 EISENHOWER AVENUE - SUITE 200
City ALEXANDRIA
State VA
ZIP 22314
Phone 703 518-4333
CertificateType 4
CertificateEffectiveDate 4/1/2024
CertificateExpirationDate 3/31/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024