Provider Demographics
NPI:1609234574
Name:IMMACULATE ANAGHO, ANJEH FORBA
Entity Type:Individual
Prefix:
First Name:ANJEH FORBA
Middle Name:
Last Name:IMMACULATE ANAGHO
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 1:8046 IANS ALY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-6133
Mailing Address - Country:US
Mailing Address - Phone:240-646-2059
Mailing Address - Fax:
Practice Address - Street 1:6229 64TH AVE APT 5
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2952
Practice Address - Country:US
Practice Address - Phone:240-646-2059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11733374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide