Healthcare Provider Details

I. General information

NPI: 1942826755
Provider Name (Legal Business Name): CREDIBLE HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 37TH PL SE APT 202
WASHINGTON DC
20019-3216
US

IV. Provider business mailing address

413 37TH PL SE APT 202
WASHINGTON DC
20019-3216
US

V. Phone/Fax

Practice location:
  • Phone: 240-640-1728
  • Fax: 877-682-6518
Mailing address:
  • Phone: 240-640-1728
  • Fax: 877-682-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAUL NTOH MBANG
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 240-640-1728