Edwan Agwah Mbaku

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

104 Steeple Chase Way
Upper Marlboro, MD 20774-1132

Phone

(240) 441-3944

NPI assigned

Jun 28, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Comfort Support Home, LLC

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Falls Church, VA
  • NPI 1457905598
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1063776581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5914 85TH AVE",
            "city": "NEW CARROLLTON",
            "state": "MD",
            "postal_code": "207842802",
            "telephone_number": "240-441-3944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 STEEPLE CHASE WAY",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207741132",
            "telephone_number": "240-441-3944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBAKU",
        "first_name": "EDWAN",
        "middle_name": "AGWAH",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridget Mbah
• Comfort Chidochirim Mbah
• Dorice Buek Mbah
• Joyce Lepyonga Mbah
• Kingsly Mbah
• Dorothy Eposi Mbellason, CRNP-PMH
• Liticia Chou Mbeng
• Raisa Betanga Mbohwoh
• Melvis Mbongu
• Agi Mboob

• Community/Behavioral Health Agency in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Community/Behavioral Health Agency in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.