Healthcare Provider Details

I. General information

NPI: 1639530801
Provider Name (Legal Business Name): POLICAP ACHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 9TH ST NW
WASHINGTON DC
20001-3344
US

IV. Provider business mailing address

4601 E WEST HWY
RIVERDALE MD
20737-1028
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-9111
  • Fax: 202-483-8181
Mailing address:
  • Phone: 202-848-8058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: