Provider Demographics
NPI:1558997973
Name:ACHA AKUM, MODESTA
Entity Type:Individual
Prefix:
First Name:MODESTA
Middle Name:
Last Name:ACHA AKUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 E WEST HWY
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1028
Mailing Address - Country:US
Mailing Address - Phone:202-390-4137
Mailing Address - Fax:
Practice Address - Street 1:4601 E WEST HWY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1028
Practice Address - Country:US
Practice Address - Phone:202-390-4137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide