=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154741775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARENE HEALTH CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2014
-----------------------------------------------------
Last Update Date | 04/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6323 GEORGIA AVE NW STE 107
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-621-7420
-----------------------------------------------------
Fax | 202-621-7422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6323 GEORGIA AVE NW STE 107
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-621-7420
-----------------------------------------------------
Fax | 202-621-7422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | IRENE AZIAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-254-3016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | NSA-0169
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------