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General NPI Number Information
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NPI Number | 1710206438
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Entity Type | Organization
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Legal Business Name | ET HOME HEALTH AGENCY
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Dates
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Enumeration Date | 05/20/2010
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 13111 3RD ST
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City | BOWIE
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State | MD
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Zip | 20720-3746
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Country | US
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Telephone | 240-441-2829
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Fax | 240-206-9396
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Provider Business Mailing Address
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Address Line | 13111 3RD ST
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City | BOWIE
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State | MD
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Zip | 20720-3746
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Country | US
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Telephone | 240-441-2829
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Fax | 240-206-9396
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Authorized Official
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Title or Position | DIRECTOR
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Name | ETA STEPHEN TATAW
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Credential | RN, MSN
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Telephone | 240-441-2829
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | R2913P
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License Number State | MD
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