Healthcare Provider Details

I. General information

NPI: 1659673374
Provider Name (Legal Business Name): HOLY FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 N CAPITOL ST NW STE 6
WASHINGTON DC
20011-1416
US

IV. Provider business mailing address

6210 N CAPITOL ST NW STE 6
WASHINGTON DC
20011-1416
US

V. Phone/Fax

Practice location:
  • Phone: 301-905-8752
  • Fax: 301-577-3813
Mailing address:
  • Phone: 301-905-8752
  • Fax: 301-577-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number300000099984
License Number StateDC

VIII. Authorized Official

Name: MRS. BENEDICTA VIGER AZONGHO
Title or Position: D.O.N
Credential: RN
Phone: 301-404-9059