Healthcare Provider Details

I. General information

NPI: 1487576427
Provider Name (Legal Business Name): GODLOVE ABONGHO NKIMIH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 JOHNSBERG LN
BOWIE MD
20721-7230
US

IV. Provider business mailing address

111 JOHNSBERG LN
BOWIE MD
20721-7230
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-9192
  • Fax:
Mailing address:
  • Phone: 301-257-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: