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NPI Code Detail

MEDICARE: NJAH SIMON TETUH

MEDICARE: NJAH SIMON TETUH
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
1374U00000XHome Health AideDC
2171M00000XCase Manager/Care Coordinator
3251S00000XCommunity/Behavioral Health AgencyDC

General Provider Information

NPI Number : 1215291638
Entity Type Code : Individual
Provider Name (Legal Business Name) : NJAH SIMON TETUH
Provider Business Mailing Address
First Line : 10005 E FRANKLIN AVE
Second Line :
City : GLENN DALE
State : MD
Zip : 20769-9279
Country : US
Telephone Number : 240-550-1174
Fax Number :
Provider Business Practice Location Address
First Line : 4660 MARTIN LUTHER KING JR AVE SW STE A1
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-4958
Country : US
Telephone Number : 202-318-0179
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2012
Last Update Date : 04/10/2025

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