Healthcare Provider Details

I. General information

NPI: 1881065167
Provider Name (Legal Business Name): EUNICE E ADEGOKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 12TH ST SE STE G35
WASHINGTON DC
20003-3738
US

IV. Provider business mailing address

5453 NEWTON ST APT 4
HYATTSVILLE MD
20784-1057
US

V. Phone/Fax

Practice location:
  • Phone: 202-544-8090
  • Fax: 202-544-8091
Mailing address:
  • Phone: 240-413-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA7032
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: