Provider Demographics
NPI:1942472238
Name:ANGEL LOVING CARE 1 INC
Entity Type:Organization
Organization Name:ANGEL LOVING CARE 1 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIATU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-937-0188
Mailing Address - Street 1:7375 EXECUTIVE PL STE 401
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6232
Mailing Address - Country:US
Mailing Address - Phone:301-937-0188
Mailing Address - Fax:301-937-0188
Practice Address - Street 1:7375 EXECUTIVE PL STE 401
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6232
Practice Address - Country:US
Practice Address - Phone:301-937-0188
Practice Address - Fax:301-937-0188
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANGEL LOVING CARE 1 INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039707300Medicaid