Provider Demographics
NPI:1073097622
Name:TRIPLE ANGELS HOMECARE SERVICES, INC.
Entity Type:Organization
Organization Name:TRIPLE ANGELS HOMECARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NKEIRU
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-212-0222
Mailing Address - Street 1:1210 DIXIE BOWIE WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774
Mailing Address - Country:US
Mailing Address - Phone:301-212-0222
Mailing Address - Fax:301-249-8630
Practice Address - Street 1:1210 DIXIE BOWIE WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-212-0222
Practice Address - Fax:301-249-8630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD900054200Medicaid