Provider Demographics
NPI:1326687336
Name:ACHA, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:ACHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11437 CHERRY HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3640
Mailing Address - Country:US
Mailing Address - Phone:949-266-7846
Mailing Address - Fax:
Practice Address - Street 1:1220 12TH ST SE STE G35
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3738
Practice Address - Country:US
Practice Address - Phone:202-544-8090
Practice Address - Fax:202-544-8091
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14431374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide