Healthcare Provider Details

I. General information

NPI: 1669318564
Provider Name (Legal Business Name): RB ANGELS HAVEN HEALTH CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 HAMLIN ST NE
WASHINGTON DC
20018-2530
US

IV. Provider business mailing address

2603 HAMLIN ST NE
WASHINGTON DC
20018-2530
US

V. Phone/Fax

Practice location:
  • Phone: 202-730-6559
  • Fax: 202-574-1918
Mailing address:
  • Phone: 202-730-6559
  • Fax: 202-574-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARY TESSIE THULLAH BANGURA
Title or Position: DNP
Credential: MD
Phone: 202-730-6559