Healthcare Provider Details

I. General information

NPI: 1942472238
Provider Name (Legal Business Name): ANGEL LOVING CARE 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 10/05/2022
Certification Date: 10/03/2022
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: 301-937-0188
Mailing address:
  • Phone: 301-937-0188
  • Fax: 301-937-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. FATIATU JOBI
Title or Position: DIRECTOR
Credential:
Phone: 301-937-0188