Provider Demographics
NPI:1851625131
Name:EMMANUEL HOME HEALTH CARE FOR ADULTS AND SENIORS
Entity Type:Organization
Organization Name:EMMANUEL HOME HEALTH CARE FOR ADULTS AND SENIORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:I'M THE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:MANGOUA
Authorized Official - Last Name:MONTHEU
Authorized Official - Suffix:
Authorized Official - Credentials:CNA STU, CFSM
Authorized Official - Phone:301-396-3501
Mailing Address - Street 1:451 HUNGERFORD DR STE 119-277
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4151
Mailing Address - Country:US
Mailing Address - Phone:301-396-3501
Mailing Address - Fax:
Practice Address - Street 1:11756 ASHWORTH CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-1634
Practice Address - Country:US
Practice Address - Phone:301-396-3501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW13056122251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health