Provider Demographics
NPI:1386905735
Name:KBC NURSING AGENCY AND HOME HEALTH CARE INC.
Entity type:Organization
Organization Name:KBC NURSING AGENCY AND HOME HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-291-6973
Mailing Address - Street 1:790 FAIRVIEW AVE
Mailing Address - Street 2:APPARTEMENT 413
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MARYLAND
Mailing Address - Zip Code:20912
Mailing Address - Country:UM
Mailing Address - Phone:240-705-0959
Mailing Address - Fax:
Practice Address - Street 1:790 FAIRVIEW AVE
Practice Address - Street 2:APPT 413
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-5979
Practice Address - Country:US
Practice Address - Phone:240-705-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT-352-174-080-684313M00000X
DC37313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC37Medicaid