Healthcare Provider Details

I. General information

NPI: 1770122863
Provider Name (Legal Business Name): ISIDORE NGELEFAC NJUNGWA HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW STE 400
WASHINGTON DC
20012-1316
US

IV. Provider business mailing address

10009 GREENBELT RD APT 101
LANHAM MD
20706-2231
US

V. Phone/Fax

Practice location:
  • Phone: 202-545-1630
  • Fax:
Mailing address:
  • Phone: 240-595-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14886
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: