Provider Demographics
NPI:1346682127
Name:DAKIM, CLETUS OBI (HHA)
Entity type:Individual
Prefix:
First Name:CLETUS
Middle Name:OBI
Last Name:DAKIM
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 CASTLE BLVD
Mailing Address - Street 2:APT 22
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7304
Mailing Address - Country:US
Mailing Address - Phone:240-715-5590
Mailing Address - Fax:
Practice Address - Street 1:13801 CASTLE BLVD
Practice Address - Street 2:APT 22
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7304
Practice Address - Country:US
Practice Address - Phone:240-715-5590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1005192164W00000X
DCHHA8995374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No164W00000XNursing Service ProvidersLicensed Practical Nurse