Healthcare Provider Details

I. General information

NPI: 1215304951
Provider Name (Legal Business Name): ETHELBERT OGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 GEORGIA AVENUE
WASHINGTON DC
20012
US

IV. Provider business mailing address

7600 GEORGIA AVENUE
WASHINGTON DC
20012
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-3060
  • Fax: 202-723-3065
Mailing address:
  • Phone: 202-723-3060
  • Fax: 202-723-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA11317
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: