Healthcare Provider Details

I. General information

NPI: 1295315091
Provider Name (Legal Business Name): ALICE EPOTE EPSE NDILLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 BASKERVILLE DR
BOWIE MD
20721-2403
US

IV. Provider business mailing address

3715 BASKERVILLE DR
BOWIE MD
20721-2403
US

V. Phone/Fax

Practice location:
  • Phone: 240-616-8141
  • Fax:
Mailing address:
  • Phone: 240-616-8141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: