=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376694869
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KBC NURSING AGENCY HM HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2007
-----------------------------------------------------
Last Update Date | 03/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7506 GEORGIA AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20012-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-291-6973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7506 GEORGIA AVE NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20012-1608
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-291-6973
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. CHRISTINE N WILLIAMS
-----------------------------------------------------
Credential | MBPA, RN
-----------------------------------------------------
Telephone | 202-291-6973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 65003496
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------