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NPI Code Detail

MEDICARE: CALISTUS AGWO

MEDICARE: CALISTUS AGWO
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
13747P1801XPersonal Care Attendant
2374U00000XHome Health Aide

General Provider Information

NPI Number : 1871129650
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALISTUS AGWO
Provider Business Mailing Address
First Line : 3610 HAMILTON ST
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-3945
Country : US
Telephone Number : 240-429-2836
Fax Number :
Provider Business Practice Location Address
First Line : 3610 HAMILTON ST
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20782-3945
Country : US
Telephone Number : 240-429-2836
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2020
Last Update Date : 10/25/2023

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Directions to “ CALISTUS AGWO ” Practice Location

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