Provider Demographics
NPI:1710206438
Name:ET HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:ET HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ETA
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TATAW
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:240-441-2829
Mailing Address - Street 1:13111 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3746
Mailing Address - Country:US
Mailing Address - Phone:240-441-2829
Mailing Address - Fax:240-206-9396
Practice Address - Street 1:13111 3RD ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3746
Practice Address - Country:US
Practice Address - Phone:240-441-2829
Practice Address - Fax:240-206-9396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2913P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health