Individual
NDE ALOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1221 TAYLOR ST NW, WASHINGTON, DC 20011-5617
(202) 464-9200
(202) 291-2160
Mailing address
12425 GLADYS RETREAT CIR, BOWIE, MD 20720-3347
(240) 505-8066
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
12/28/2011
Last updated
06/17/2023
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