Provider Demographics
NPI:1598799124
Name:IMMACULATE HEALTH CARE SERVICES,INC
Entity Type:Organization
Organization Name:IMMACULATE HEALTH CARE SERVICES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-832-8340
Mailing Address - Street 1:2512 24TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2126
Mailing Address - Country:US
Mailing Address - Phone:202-832-8340
Mailing Address - Fax:202-832-8341
Practice Address - Street 1:2512 24TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018
Practice Address - Country:US
Practice Address - Phone:202-832-8340
Practice Address - Fax:202-832-8341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC-64001387251E00000X
DC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036889400Medicaid
DC035810300Medicaid
DC035997600Medicaid
DC097056Medicare Oscar/Certification