Provider Demographics
NPI:1053721811
Name:ENETARO NKWOCHA
Entity type:Organization
Organization Name:ENETARO NKWOCHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRITORSHIP/ CNA
Authorized Official - Prefix:
Authorized Official - First Name:ENETARO
Authorized Official - Middle Name:
Authorized Official - Last Name:NKWOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1240-413-6199
Mailing Address - Street 1:5722 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706
Mailing Address - Country:US
Mailing Address - Phone:240-413-6199
Mailing Address - Fax:
Practice Address - Street 1:5722 GLEN AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4730
Practice Address - Country:US
Practice Address - Phone:240-413-6199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care