Healthcare Provider Details

I. General information

NPI: 1225471907
Provider Name (Legal Business Name): ABEDNEGO AMBE ACHAMBA HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 E 10TH AVE APT 3
ANCHORAGE AK
99501-4052
US

IV. Provider business mailing address

1226 E 10TH AVE APT 3
ANCHORAGE AK
99501-4052
US

V. Phone/Fax

Practice location:
  • Phone: 202-961-4920
  • Fax:
Mailing address:
  • Phone: 202-961-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: