=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134579915
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HHA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2016
-----------------------------------------------------
Last Update Date | 06/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6931 WOODSTREAM LANE
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-618-7906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6931 WOODSTREAM LANE
-----------------------------------------------------
City | LANHAM
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-618-7906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOME HEALTH AID
-----------------------------------------------------
Name | DARELLE D PATOTCHOU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-618-7906
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | HHA12022
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------