Healthcare Provider Details

I. General information

NPI: 1962270389
Provider Name (Legal Business Name): EMMACULATE KOYE TATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KENILWORTH TER NE APT 209
WASHINGTON DC
20019-1521
US

IV. Provider business mailing address

750 KENILWORTH TER NE APT 209
WASHINGTON DC
20019-1521
US

V. Phone/Fax

Practice location:
  • Phone: 202-627-9083
  • Fax:
Mailing address:
  • Phone: 202-627-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHHH200003311
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: