Provider Demographics
NPI:1427620764
Name:KUMEDZRO, LAKISHA (CEO)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:KUMEDZRO
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 OLD PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:GAP
Mailing Address - State:PA
Mailing Address - Zip Code:17527-9227
Mailing Address - Country:US
Mailing Address - Phone:717-429-6834
Mailing Address - Fax:
Practice Address - Street 1:5571 OLD PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9227
Practice Address - Country:US
Practice Address - Phone:717-429-6834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty