Healthcare Provider Details

I. General information

NPI: 1255189924
Provider Name (Legal Business Name): MR. ANISIS ACHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7024
US

IV. Provider business mailing address

9 VILLAGE GREEN CT
GERMANTOWN MD
20876-6953
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-1700
  • Fax:
Mailing address:
  • Phone: 978-596-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200006331
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: