Provider Demographics
NPI:1578937611
Name:BAH EPSE FRU, RELINDIS MANGIE I (HHA)
Entity Type:Individual
Prefix:MRS
First Name:RELINDIS
Middle Name:MANGIE
Last Name:BAH EPSE FRU
Suffix:I
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7072 HANOVER PKWY APT D1
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2072
Mailing Address - Country:US
Mailing Address - Phone:240-408-9560
Mailing Address - Fax:
Practice Address - Street 1:7072 HANOVER PKWY APT D1
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2072
Practice Address - Country:US
Practice Address - Phone:240-408-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-28
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11615374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health