Healthcare Provider Details

I. General information

NPI: 1194246611
Provider Name (Legal Business Name): PEKLINS BUMA TAAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 SPRINGHILLS LANE APT 204 GREENBELT MD
GREENBELT MD MD
20770
US

IV. Provider business mailing address

9125 SPRINGHILL LN
GREENBELT MD
20770-1219
US

V. Phone/Fax

Practice location:
  • Phone: 443-968-6652
  • Fax:
Mailing address:
  • Phone: 443-968-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12826
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: