Healthcare Provider Details

I. General information

NPI: 1740143346
Provider Name (Legal Business Name): ANIM TENENG GLORY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12314 EUGENES PROSPECT DR
BOWIE MD
20720-3372
US

IV. Provider business mailing address

12314 EUGENES PROSPECT DR
BOWIE MD
20720-3372
US

V. Phone/Fax

Practice location:
  • Phone: 202-487-9657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2000005691
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: