Basic Information
| Provider Information | |||||||||
| NPI: | 1598799124 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IMMACULATE HEALTH CARE SERVICES,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2512 24TH ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200182126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028328340 | ||||||||
| FaxNumber: | 2028328341 | ||||||||
| Practice Location | |||||||||
| Address1: | 2512 24TH ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028328340 | ||||||||
| FaxNumber: | 2028328341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SESAY | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 2028328340 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | -64001387 | DC | N | Agencies | Home Health | 385H00000X | DC | Y | Respite Care Facility | Respite Care |
ID Information
| ID | Type | State | Issuer | Description | 036889400 | 05 | DC | MEDICAID | 035810300 | 05 | DC | MEDICAID | 035997600 | 05 | DC | MEDICAID |