Healthcare Provider Details

I. General information

NPI: 1023754231
Provider Name (Legal Business Name): ANGEL LOVING CARE 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 05/10/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 EXECUTIVE PL STE 401
LANHAM MD
20706-6232
US

IV. Provider business mailing address

7375 EXECUTIVE PL STE 401
LANHAM MD
20706-6232
US

V. Phone/Fax

Practice location:
  • Phone: 301-937-0188
  • Fax: 240-260-3538
Mailing address:
  • Phone: 301-937-0188
  • Fax: 240-260-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FATIATU JOBI
Title or Position: OWNER
Credential:
Phone: 301-937-0188