Provider Demographics
NPI:1053863381
Name:ANGEL SENIOR HOME CARE, LLC-MCLEAN
Entity Type:Organization
Organization Name:ANGEL SENIOR HOME CARE, LLC-MCLEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAI
Authorized Official - Middle Name:D
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-216-4727
Mailing Address - Street 1:6723 WHITTIER AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4544
Mailing Address - Country:US
Mailing Address - Phone:571-216-4727
Mailing Address - Fax:703-971-3931
Practice Address - Street 1:6723 WHITTIER AVE STE 204
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4544
Practice Address - Country:US
Practice Address - Phone:571-216-4727
Practice Address - Fax:703-971-3931
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGE LSENIOR HOME CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-171538251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health