Healthcare Provider Details

I. General information

NPI: 1568211886
Provider Name (Legal Business Name): IRENE OWUSU ANSAH HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E JERSEY ST STE 203
ELIZABETH NJ
07201-2431
US

IV. Provider business mailing address

1139 E JERSEY ST STE 203
ELIZABETH NJ
07201-2431
US

V. Phone/Fax

Practice location:
  • Phone: 732-226-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number26NH21915000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: