Ics

NPI 1194128819 - Assisted Living Facility - 3104A0625X

NPI Details
NPI 1194128819
Enumeration Date 10/08/2014
Last Updated 10/08/2014
Entity Type Healthcare Provider
Active Over 2 years ago
Authorized Information
Name CLOTILDE CLOTILDE
Position HHA
Phone (240) 467-4139
Fax
Practice Location
1234 SOUTHERN AVE SE APT 301
WASHINGTON DC, 20032-4620, US
Phone (240) 467-4139
Fax
Business Location
1234 SOUTHERN AVE SE APT 301
WASHINGTON DC, 20032-4620, US
Phone (240) 467-4139
Fax
Toxanomy
Taxonomy Code 3104A0625X
License State DO Columbia
License Number HHA10972
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According to our database, Ics NPI is 1194128819, taxonomy code is 3104A0625X and license number is HHA10972, license state is located at DO Columbia. Ics physically located at 1234 Southern Ave Se Apt 301, Washington DC, 20032-4620. NPI Number 1033115704 has the healthcare provider type.

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1194128819 NPI number is provided on an as is basis without warranty of any kind. 1194128819 is maintained by the National Plan & Provider Enumeration System. The contents of Ics are for informational purposes only.