Healthcare Provider Details

I. General information

NPI: 1184183311
Provider Name (Legal Business Name): ANGELIC PLACE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 WARRENTON RD STE 109
FREDERICKSBURG VA
22406-1098
US

IV. Provider business mailing address

754 WARRENTON RD STE 109
FREDERICKSBURG VA
22406-1098
US

V. Phone/Fax

Practice location:
  • Phone: 540-479-2756
  • Fax: 540-642-4569
Mailing address:
  • Phone: 540-479-2756
  • Fax: 540-642-4569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EMIGDUS L NKEM
Title or Position: DIRECTOR
Credential:
Phone: 571-494-7066