Provider Demographics
NPI:1194370809
Name:BAH, JENEBA
Entity type:Individual
Prefix:
First Name:JENEBA
Middle Name:
Last Name:BAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENEBA
Other - Middle Name:
Other - Last Name:BAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HOME HEALTH AIDE
Mailing Address - Street 1:318 OLD FORGE LN
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2989
Mailing Address - Country:US
Mailing Address - Phone:240-764-9280
Mailing Address - Fax:
Practice Address - Street 1:318 OLD FORGE LN
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2989
Practice Address - Country:US
Practice Address - Phone:240-764-9280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14085374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide