Healthcare Provider Details

I. General information

NPI: 1477029932
Provider Name (Legal Business Name): JOY BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEWTON ST NW
WASHINGTON DC
20010-1017
US

IV. Provider business mailing address

1818 NEWTON ST NW
WASHINGTON DC
20010-1017
US

V. Phone/Fax

Practice location:
  • Phone: 202-328-7400
  • Fax:
Mailing address:
  • Phone: 202-328-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14114
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA00338192
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: