Healthcare Provider Details

I. General information

NPI: 1841920303
Provider Name (Legal Business Name): INCANI HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 MINNESOTA WAY
UPPER MARLBORO MD
20774-6060
US

IV. Provider business mailing address

1316 MINNESOTA WAY
UPPER MARLBORO MD
20774-6060
US

V. Phone/Fax

Practice location:
  • Phone: 202-256-4940
  • Fax:
Mailing address:
  • Phone: 202-256-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NGWOBIA C IDIKA
Title or Position: ADMINISTRATOR
Credential:
Phone: 202-702-6789