MEDICARE: AKWUA PASCAL TUMENTA II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1851095145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKWUA PASCAL TUMENTA II

Provider Business Mailing Address
First Line	:	3560 MORNING STAR PL
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20724-5964
Country	:	US
Telephone Number	:	240-253-7291
Fax Number	:	240-253-7291

Provider Business Practice Location Address
First Line	:	2811 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3865
Country	:	US
Telephone Number	:	202-894-6811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2023
Last Update Date	:	08/02/2023

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