Healthcare Provider Details

I. General information

NPI: 1235729054
Provider Name (Legal Business Name): SHECKEL HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 NEW JERSEY AVE NW
WASHINGTON DC
20001-1225
US

IV. Provider business mailing address

1205 NEW JERSEY AVE NW
WASHINGTON DC
20001-1225
US

V. Phone/Fax

Practice location:
  • Phone: 202-735-6262
  • Fax:
Mailing address:
  • Phone: 202-735-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN ADEWALE
Title or Position: CEO
Credential:
Phone: 202-735-6262