Healthcare Provider Details

I. General information

NPI: 1770309122
Provider Name (Legal Business Name): 4 ANGELS HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16213 OWL EAGLE CT
WOODBRIDGE VA
22191-6537
US

IV. Provider business mailing address

16213 OWL EAGLE CT
WOODBRIDGE VA
22191-6537
US

V. Phone/Fax

Practice location:
  • Phone: 202-495-9260
  • Fax:
Mailing address:
  • Phone: 202-495-9260
  • Fax:

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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. AISHA ZADRAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 202-495-9260