Provider Demographics
NPI:1538702717
Name:DADA, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:DADA
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 1:1801 BELLE HAVEN DR APT 304
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4022
Mailing Address - Country:US
Mailing Address - Phone:215-805-3347
Mailing Address - Fax:
Practice Address - Street 1:1801 BELLE HAVEN DR APT 304
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4022
Practice Address - Country:US
Practice Address - Phone:215-805-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14736374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty