Provider Demographics
NPI:1366058802
Name:LIKAMBI, COMFORT
Entity type:Individual
Prefix:
First Name:COMFORT
Middle Name:
Last Name:LIKAMBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7813 ANDERSON LN APT 303
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-3986
Mailing Address - Country:US
Mailing Address - Phone:301-746-2961
Mailing Address - Fax:
Practice Address - Street 1:7813 ANDERSON LN APT 303
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-3986
Practice Address - Country:US
Practice Address - Phone:301-746-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC81725251E00000X
DCHHA15469374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCHHA15469Medicaid