Provider Demographics
NPI:1528546967
Name:NGONGWE, STEVE ELAD (HHA)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:ELAD
Last Name:NGONGWE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 RIVERDALE RD APT 302
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3943
Mailing Address - Country:US
Mailing Address - Phone:301-503-2129
Mailing Address - Fax:
Practice Address - Street 1:9005 WALLACE RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4211
Practice Address - Country:US
Practice Address - Phone:301-503-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-28
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13876374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA13876OtherHHA