Provider Demographics
NPI:1841952066
Name:OKOBI, RITA KIMBLE
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:KIMBLE
Last Name:OKOBI
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 1:11720 BELTSVILLE DR STE 500-A07
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3166
Mailing Address - Country:US
Mailing Address - Phone:240-543-7873
Mailing Address - Fax:240-559-2354
Practice Address - Street 1:11720 BELTSVILLE DR STE 500-A07
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3166
Practice Address - Country:US
Practice Address - Phone:240-543-7873
Practice Address - Fax:240-559-2354
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5258091800Medicaid