Provider Demographics
NPI:1619230224
Name:ULTRA HOME HEALTH AGENCY
Entity type:Organization
Organization Name:ULTRA HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AIDS
Authorized Official - Prefix:MISS
Authorized Official - First Name:EVELYNE
Authorized Official - Middle Name:NGUETSOP
Authorized Official - Last Name:SOBGO
Authorized Official - Suffix:
Authorized Official - Credentials:HOME HEALTH CARE
Authorized Official - Phone:267-266-0833
Mailing Address - Street 1:10728 CASTLETON WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1470
Mailing Address - Country:US
Mailing Address - Phone:267-266-0833
Mailing Address - Fax:
Practice Address - Street 1:439 ONEIDA PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-2150
Practice Address - Country:US
Practice Address - Phone:202-291-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC62407251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health