Provider Demographics
NPI:1194370809
Name:BAH, JENEBA
Entity Type:Individual
Prefix:
First Name:JENEBA
Middle Name:
Last Name:BAH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENEBA
Other - Middle Name:
Other - Last Name:BAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH AIDE
Mailing Address - Street 1:3301 NEW MEXICO AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3622
Mailing Address - Country:US
Mailing Address - Phone:202-683-7717
Mailing Address - Fax:
Practice Address - Street 1:13172 LARCHDALE RD APT 8
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1772
Practice Address - Country:US
Practice Address - Phone:240-486-9733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14085374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide