Provider Demographics
NPI:1528557329
Name:ACHEAMPONG, LINA KUNADU I (CEO)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:KUNADU
Last Name:ACHEAMPONG
Suffix:I
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1516
Mailing Address - Country:US
Mailing Address - Phone:860-995-2711
Mailing Address - Fax:860-995-2711
Practice Address - Street 1:52 MERCER AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1516
Practice Address - Country:US
Practice Address - Phone:860-995-2711
Practice Address - Fax:860-995-2711
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTHCA.0001377374U00000X, 376J00000X
CTNA8236151376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNA7236151OtherCNA
NONEOtherNONE
NA8236151OtherCNA
CTNA8236151OtherCNA