Healthcare Provider Details

I. General information

NPI: 1215394556
Provider Name (Legal Business Name): MOXIE G2 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 11/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44927 GEORGE WASHINGTON BLVD SUITE 145
ASHBURN VA
20147-4295
US

IV. Provider business mailing address

44927 GEORGE WASHINGTON BLVD SUITE 145
ASHBURN VA
20147-4295
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-7317
  • Fax: 703-348-6213
Mailing address:
  • Phone: 703-574-7317
  • Fax: 703-348-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHCO-181471
License Number StateVA

VIII. Authorized Official

Name: MRS. ANGELA HOWELL
Title or Position: OWNER/COO
Credential: RN, BSN, MPH
Phone: 703-574-7317