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General NPI Number Information
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NPI Number | 1104691302
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Entity Type | Organization
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Legal Business Name | A&O SUPREME CARE
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Dates
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Enumeration Date | 11/17/2023
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 4200 EVERGREEN LN STE 332
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City | ANNANDALE
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State | VA
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Zip | 22003-3252
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Country | US
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Telephone | 240-821-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 4807 TYLERS HOPE DR
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City | BOWIE
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State | MD
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Zip | 20720-6303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUDITH NGIEH
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Credential |
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Telephone | 240-821-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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