Healthcare Provider Details

I. General information

NPI: 1750868444
Provider Name (Legal Business Name): AROUNA WUBUTA WUNDU HHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11207 CHAMPLAIN CIR
BOWIE MD
20720-3490
US

IV. Provider business mailing address

5804 QUEENS CHAPEL RD APT 3
HYATTSVILLE MD
20782-3869
US

V. Phone/Fax

Practice location:
  • Phone: 240-850-5443
  • Fax:
Mailing address:
  • Phone: 240-850-5443
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13714
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: