Provider Demographics
NPI:1649521923
Name:MBA, HELSA NDOME KOKO (HHA)
Entity type:Individual
Prefix:
First Name:HELSA
Middle Name:NDOME KOKO
Last Name:MBA
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MARC RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1526
Mailing Address - Country:US
Mailing Address - Phone:443-535-5330
Mailing Address - Fax:202-545-0176
Practice Address - Street 1:520 MARC RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1526
Practice Address - Country:US
Practice Address - Phone:443-535-5330
Practice Address - Fax:202-545-0176
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide