Provider Demographics
NPI:1811346521
Name:KBC HOME HEALTH CARE
Entity type:Organization
Organization Name:KBC HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-732-2773
Mailing Address - Street 1:1508 NEAL ST NE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3969
Mailing Address - Country:US
Mailing Address - Phone:301-732-2773
Mailing Address - Fax:
Practice Address - Street 1:1508 NEAL ST NE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3969
Practice Address - Country:US
Practice Address - Phone:301-732-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11764305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization