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General NPI Number Information
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NPI Number | 1053863381
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Entity Type | Organization
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Legal Business Name | ANGEL SENIOR HOME CARE, LLC-MCLEAN
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 11/14/2016
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Provider Practice Location Address
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Address Line | 6723 WHITTIER AVE STE 204
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City | MC LEAN
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State | VA
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Zip | 22101-4544
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Country | US
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Telephone | 571-216-4727
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Fax | 703-971-3931
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Provider Business Mailing Address
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Address Line | 6723 WHITTIER AVE STE 204
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City | MC LEAN
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State | VA
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Zip | 22101-4544
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Country | US
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Telephone | 571-216-4727
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Fax | 703-971-3931
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAI D KOHLI
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Credential |
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Telephone | 571-216-4727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HCO-171538
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License Number State | VA
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