Individual
JUDE THADDEUS YUSIMBOM SONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
HOME HEALTH AIDE
Contact information
Practice address
2811 PENNSYLVANIA AVE SE, WASHINGTON, DC 20020-3865
(202) 894-6811
(202) 894-6811
Mailing address
5501 DORIS CT, BLADENSBURG, MD 20710-1649
(240) 825-8691
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN200002497
DC
171M00000X
Case Manager/Care Coordinator
—
—
374U00000X
Home Health Aide
HHA13466
DC
376K00000X
Nurse's Aide
256963753
DC
Other
Enumeration date
01/04/2018
Last updated
08/14/2023
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