Provider Demographics
NPI:1336943893
Name:ACHA, JAVIS TITA
Entity type:Individual
Prefix:
First Name:JAVIS TITA
Middle Name:
Last Name:ACHA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 METZEROTT RD APT 302
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3442
Mailing Address - Country:US
Mailing Address - Phone:240-659-8662
Mailing Address - Fax:
Practice Address - Street 1:1836 METZEROTT RD APT 302
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-3442
Practice Address - Country:US
Practice Address - Phone:240-659-8662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide