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General NPI Number Information
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NPI Number | 1427546357
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Entity Type | Organization
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Legal Business Name | HOUSE OF ANGELS, LLC
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Dates
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Enumeration Date | 04/26/2018
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 2630 MYRTLE AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2630
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Country | US
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Telephone | 202-248-2154
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Fax |
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Provider Business Mailing Address
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Address Line | 2630 MYRTLE AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2630
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Country | US
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Telephone | 202-248-2154
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHIDI IHUOMA
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Credential | LPN
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Telephone | 202-432-9412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | CRF000961
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License Number State | DC
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