Provider Demographics
NPI:1205670346
Name:GORHAM, ROCHELLE LATICE
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:LATICE
Last Name:GORHAM
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 1:2300 MARION BARRY AVE SE APT 1023
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5136
Mailing Address - Country:US
Mailing Address - Phone:202-865-4023
Mailing Address - Fax:202-865-4936
Practice Address - Street 1:2300 MARION BARRY AVE SE APT 1023
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5136
Practice Address - Country:US
Practice Address - Phone:202-200-6109
Practice Address - Fax:202-865-4936
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty