Healthcare Provider Details

I. General information

NPI: 1649530486
Provider Name (Legal Business Name): MR. VERNON ABIA AKU OFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6856 EASTERN AVE NW STE 350
WASHINGTON DC
20012-2166
US

IV. Provider business mailing address

6114 BREEZEWOOD DR APT 202
GREENBELT MD
20770-4143
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-0211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: