Provider Demographics
NPI:1023321452
Name:HOUSE OF QUTE4REVA, LLC
Entity type:Organization
Organization Name:HOUSE OF QUTE4REVA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:C
Authorized Official - Last Name:AWUSAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-217-0024
Mailing Address - Street 1:3116 QUARTET LN
Mailing Address - Street 2:SUITE 226
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6823
Mailing Address - Country:US
Mailing Address - Phone:301-217-0024
Mailing Address - Fax:
Practice Address - Street 1:4800 HAMPDEN LN
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2930
Practice Address - Country:US
Practice Address - Phone:301-217-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSE OF QUTE4REVA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care