Organization
PROFESSIONAL HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MONIQUE JACKSON (HOME HEALTH AIDE)
(240) 224-6394
Entity
Organization
Contact information
Practice address
1010 WISCONSIN AVE NW, WASHINGTON, DC 20007-3603
(202) 955-8355
Mailing address
945 DIVISION AVE NE APT 4, WASHINGTON, DC 20019
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
HHA9912
DC
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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