Provider Demographics
NPI:1962078790
Name:ACHU, VITALIS ACHA
Entity type:Individual
Prefix:
First Name:VITALIS ACHA
Middle Name:
Last Name:ACHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11437 CHERRY HILL RD APT 101
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3640
Mailing Address - Country:US
Mailing Address - Phone:202-894-5806
Mailing Address - Fax:
Practice Address - Street 1:11437 CHERRY HILL RD APT 101
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3640
Practice Address - Country:US
Practice Address - Phone:202-894-5806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide