Provider Demographics
NPI:1720687478
Name:E & A PEDIATRIC HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:E & A PEDIATRIC HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MBONO
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NURSE
Authorized Official - Phone:301-806-2953
Mailing Address - Street 1:658 CHAPELGATE DR
Mailing Address - Street 2:ODENTON
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:301-806-2953
Mailing Address - Fax:304-728-0839
Practice Address - Street 1:207 W. WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-724-2135
Practice Address - Fax:304-728-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health