MEDICARE: POUTOUMA EBANGHA CHINJECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1124742069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POUTOUMA EBANGHA CHINJECK

Provider Business Mailing Address
First Line	:	6105 EASTERN AVE APT 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3381
Country	:	US
Telephone Number	:	202-652-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 EASTERN AVE APT 201
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3381
Country	:	US
Telephone Number	:	202-652-8391
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	01/12/2026

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