Basic Information
| Provider Information | |||||||||
| NPI: | 1306187745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MANNING | ||||||||
| FirstName: | RENECKA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | HHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 UNDERWOOD ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200122706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2029077709 | ||||||||
| FaxNumber: | 2026355780 | ||||||||
| Practice Location | |||||||||
| Address1: | 1731 BUNKER HILL RD NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200173026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2026355756 | ||||||||
| FaxNumber: | 2026355780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2013 | ||||||||
| LastUpdateDate: | 03/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 251E00000X | DC | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 055705600 | 05 | DC | MEDICAID |