Healthcare Provider Details

I. General information

NPI: 1376694869
Provider Name (Legal Business Name): KBC NURSING AGENCY HM HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

IV. Provider business mailing address

7506 GEORGIA AVE NW
WASHINGTON DC
20012-1608
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-6973
  • Fax:
Mailing address:
  • Phone: 202-291-6973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number65003496
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE N WILLIAMS
Title or Position: ADMINISTRATOR
Credential: MBPA, RN
Phone: 202-291-6973