Healthcare Provider Details

I. General information

NPI: 1952142408
Provider Name (Legal Business Name): AKWI ABEAMBUM ACHANGOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7006 GOOD LUCK RD
LANHAM MD
20706-3709
US

IV. Provider business mailing address

7006 GOOD LUCK RD
LANHAM MD
20706-3709
US

V. Phone/Fax

Practice location:
  • Phone: 240-610-2892
  • Fax:
Mailing address:
  • Phone: 240-610-2892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003970
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: