MEDICARE: MRS. MABEL EMAMBU FORCHA

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

General Provider Information

NPI Number	:	1326300526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MABEL EMAMBU FORCHA

Provider Business Mailing Address
First Line	:	7837 RIVERDALE RD APT 202
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4020
Country	:	US
Telephone Number	:	240-486-7471
Fax Number	:	202-722-1726

Provider Business Practice Location Address
First Line	:	7837 RIVERDALE RD APT 202
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4020
Country	:	US
Telephone Number	:	240-486-7471
Fax Number	:	202-722-1726

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

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	10/22/2018

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