Provider Demographics
NPI:1861103897
Name:A.A SHEENA CARE LLC
Entity type:Organization
Organization Name:A.A SHEENA CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAKOUTE PANKUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-741-9703
Mailing Address - Street 1:2018 SHADYSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746
Mailing Address - Country:US
Mailing Address - Phone:240-741-9703
Mailing Address - Fax:
Practice Address - Street 1:2018 SHADYSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746
Practice Address - Country:US
Practice Address - Phone:240-741-9703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A.A SHEENA CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No282E00000XHospitalsLong Term Care Hospital
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No251S00000XAgenciesCommunity/Behavioral Health
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1952841769Medicaid
VA1952841769Medicaid