Provider Demographics
NPI:1881238624
Name:ENOH, HENRY TIMBEN
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:TIMBEN
Last Name:ENOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6259 64TH AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-2968
Mailing Address - Country:US
Mailing Address - Phone:240-643-7122
Mailing Address - Fax:
Practice Address - Street 1:6259 64TH AVE APT 4
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-2968
Practice Address - Country:US
Practice Address - Phone:240-643-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14749374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide