1487713236 NPI number — MRS. JUANITA SANDRA MUSTAPHA HOME HEALTH AID

Table of content: MRS. JUANITA SANDRA MUSTAPHA HOME HEALTH AID (NPI 1487713236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487713236 NPI number — MRS. JUANITA SANDRA MUSTAPHA HOME HEALTH AID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUSTAPHA
Provider First Name:
JUANITA
Provider Middle Name:
SANDRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HOME HEALTH AID
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487713236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2802 FARRIS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20715-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-262-2976
Provider Business Mailing Address Fax Number:
301-262-2976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 58TH ST NE
Provider Second Line Business Practice Location Address:
APT. 003
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20019-6800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-377-4821
Provider Business Practice Location Address Fax Number:
301-262-2976
Provider Enumeration Date:
12/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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