Healthcare Provider Details

I. General information

NPI: 1497366959
Provider Name (Legal Business Name): SAMANTHA D RIVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GOOD HOPE RD SE APT 421
WASHINGTON DC
20020-5118
US

IV. Provider business mailing address

2300 GOOD HOPE RD SE APT 421
WASHINGTON DC
20020-5118
US

V. Phone/Fax

Practice location:
  • Phone: 202-640-8497
  • Fax:
Mailing address:
  • Phone: 202-640-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0070738331
Identifier TypeMEDICAID
Identifier StateDC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: