Healthcare Provider Details

I. General information

NPI: 1427546357
Provider Name (Legal Business Name): HOUSE OF ANGELS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 MYRTLE AVE NE
WASHINGTON DC
20018-2630
US

IV. Provider business mailing address

2630 MYRTLE AVE NE
WASHINGTON DC
20018-2630
US

V. Phone/Fax

Practice location:
  • Phone: 202-248-2154
  • Fax:
Mailing address:
  • Phone: 202-248-2154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberCRF000961
License Number StateDC

VIII. Authorized Official

Name: CHIDI IHUOMA
Title or Position: OWNER
Credential: LPN
Phone: 202-432-9412