Healthcare Provider Details

I. General information

NPI: 1528826690
Provider Name (Legal Business Name): ESOWOH HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 THISTLEWOOD DRIVE
WASHINGTON MD
20744
US

IV. Provider business mailing address

120 WATERFRONT ST STE 420
NATIONAL HARBOR MD
20745-1122
US

V. Phone/Fax

Practice location:
  • Phone: 202-304-0633
  • Fax: 443-449-5651
Mailing address:
  • Phone: 202-304-0633
  • Fax: 443-449-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AUGUSTINA FOFANAH
Title or Position: CEO
Credential: MS, BSN, RN
Phone: 202-304-0633