Healthcare Provider Details

I. General information

NPI: 1992067706
Provider Name (Legal Business Name): KEHINDE S DARE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 RANDOLPH ST NE
WASHINGTON DC
20018-3069
US

IV. Provider business mailing address

2221 RANDOLPH ST NE
WASHINGTON DC
20018-3069
US

V. Phone/Fax

Practice location:
  • Phone: 202-704-6698
  • Fax:
Mailing address:
  • Phone: 202-704-6698
  • 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: