Provider Demographics
NPI:1265140271
Name:KEM BUMBARA, RAISA ACHE
Entity type:Individual
Prefix:
First Name:RAISA ACHE
Middle Name:
Last Name:KEM BUMBARA
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 1:14740 4TH ST APT 105
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3880
Mailing Address - Country:US
Mailing Address - Phone:301-851-9963
Mailing Address - Fax:
Practice Address - Street 1:14740 4TH ST APT 105
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3880
Practice Address - Country:US
Practice Address - Phone:301-851-9963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide