Provider Demographics
NPI:1467890046
Name:ANGELS OF MERCY HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ANGELS OF MERCY HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ODHIAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-270-2266
Mailing Address - Street 1:6475 NEW HAMPSHIRE AVE
Mailing Address - Street 2:304
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3269
Mailing Address - Country:US
Mailing Address - Phone:301-270-2266
Mailing Address - Fax:301-270-2296
Practice Address - Street 1:6475 NEW HAMPSHIRE AVE
Practice Address - Street 2:304
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3269
Practice Address - Country:US
Practice Address - Phone:301-270-2266
Practice Address - Fax:301-270-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2452251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119610300Medicaid