Provider Demographics
NPI:1215660584
Name:ACHA, EDMOND KEM
Entity type:Individual
Prefix:
First Name:EDMOND
Middle Name:KEM
Last Name:ACHA
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 1:6841B RIVERDALE RD APT 202B
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1871
Mailing Address - Country:US
Mailing Address - Phone:202-247-7519
Mailing Address - Fax:
Practice Address - Street 1:9348 CHERRY HILL RD APT 116
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1281
Practice Address - Country:US
Practice Address - Phone:202-247-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide