Provider Demographics
NPI:1699204255
Name:HOLISTIC ANGEL'S CARE LLC
Entity Type:Organization
Organization Name:HOLISTIC ANGEL'S CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUKANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-832-7411
Mailing Address - Street 1:5852 POST CORNERS TRL APT K
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2528 TERRA COTTA CIR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4698
Practice Address - Country:US
Practice Address - Phone:800-225-9361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care