Provider Demographics
NPI:1215251491
Name:NUNEHE FITNESS
Entity type:Organization
Organization Name:NUNEHE FITNESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, HEALTH CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,CPFT
Authorized Official - Phone:202-588-8056
Mailing Address - Street 1:2639 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 251
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1537
Mailing Address - Country:US
Mailing Address - Phone:202-588-8056
Mailing Address - Fax:
Practice Address - Street 1:2639 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 251
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1537
Practice Address - Country:US
Practice Address - Phone:202-588-8056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC91552Medicaid
DC1555Medicaid
DC9155Medicaid
DC9155Medicaid
9155Medicare PIN