Provider Demographics
NPI:1689011017
Name:EBAGE, CLOVIS MESONGE (HHA)
Entity Type:Individual
Prefix:
First Name:CLOVIS
Middle Name:MESONGE
Last Name:EBAGE
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 PRESTON CT APT A
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2326
Mailing Address - Country:US
Mailing Address - Phone:202-545-0935
Mailing Address - Fax:202-545-0176
Practice Address - Street 1:203 PRESTON CT APT A
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2326
Practice Address - Country:US
Practice Address - Phone:202-545-0935
Practice Address - Fax:202-545-0176
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide