Healthcare Provider Details

I. General information

NPI: 1982967154
Provider Name (Legal Business Name): ETN ANGEL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 RHODE ISLAND AVE NE
WASHINGTON DC
20018-2836
US

IV. Provider business mailing address

2101 RHODE ISLAND AVE NE 102
WASHINGTON DC
20018-2836
US

V. Phone/Fax

Practice location:
  • Phone: 202-262-3610
  • Fax:
Mailing address:
  • Phone: 202-262-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NGATCHOU THEODORE
Title or Position: MANAGER
Credential:
Phone: 202-262-3610