Provider Demographics
NPI:1255756714
Name:ANGELIC HEART AT HOME CARE
Entity type:Organization
Organization Name:ANGELIC HEART AT HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLOTILDE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-330-6228
Mailing Address - Street 1:3022 JAVIER RD STE 207A
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4657
Mailing Address - Country:US
Mailing Address - Phone:703-560-6100
Mailing Address - Fax:703-560-6101
Practice Address - Street 1:3022 JAVIER RD STE 207A
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4657
Practice Address - Country:US
Practice Address - Phone:703-560-6100
Practice Address - Fax:703-560-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health