Provider Demographics
NPI:1316328123
Name:JEROME NYONGBELA
Entity type:Organization
Organization Name:JEROME NYONGBELA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:KEHBILA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAYUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-640-8916
Mailing Address - Street 1:3516 DEAN DR
Mailing Address - Street 2:P5
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1212
Mailing Address - Country:US
Mailing Address - Phone:202-640-8916
Mailing Address - Fax:
Practice Address - Street 1:3516 DEAN DR
Practice Address - Street 2:P5
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1212
Practice Address - Country:US
Practice Address - Phone:202-640-8916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOME HEALTH AGENCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11292251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health