Healthcare Provider Details

I. General information

NPI: 1740145390
Provider Name (Legal Business Name): JULIUS JUNIOR NKENGANFEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5704 85TH AVE
NEW CARROLLTON MD
20784-2927
US

IV. Provider business mailing address

5704 85TH AVE
NEW CARROLLTON MD
20784-2927
US

V. Phone/Fax

Practice location:
  • Phone: 240-714-0049
  • Fax:
Mailing address:
  • Phone: 240-714-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005800
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: