Provider Demographics
NPI:1972867331
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:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SESAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-832-8340
Mailing Address - Street 1:1532 FORT DAVIS ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6026
Mailing Address - Country:US
Mailing Address - Phone:202-468-0963
Mailing Address - Fax:
Practice Address - Street 1:1532 FORT DAVIS ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6026
Practice Address - Country:US
Practice Address - Phone:202-468-0963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70584331OtherDC CHARTERED HEALTH PLAN