Healthcare Provider Details

I. General information

NPI: 1952668873
Provider Name (Legal Business Name): KBC NURSING AGENCY AND HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 DUBOIS PL SE APT 2
WASHINGTON DC
20019-2447
US

IV. Provider business mailing address

3213 DUBOIS PL SE APT 2
WASHINGTON DC
20019-2447
US

V. Phone/Fax

Practice location:
  • Phone: 202-713-4814
  • Fax:
Mailing address:
  • Phone: 202-713-4814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number2183887
License Number StateDC

VIII. Authorized Official

Name: MRS. CHRISTINE WILLIAMS
Title or Position: OFFICIAL
Credential:
Phone: 202-291-6973