Provider Demographics
NPI:1447514005
Name:ROACH, FRENTRESS
Entity type:Individual
Prefix:
First Name:FRENTRESS
Middle Name:
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 COLUMBIA RD NW
Mailing Address - Street 2:APT. 303
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4971
Mailing Address - Country:US
Mailing Address - Phone:202-578-6995
Mailing Address - Fax:
Practice Address - Street 1:1307 COLUMBIA RD NW
Practice Address - Street 2:APT. 303
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4971
Practice Address - Country:US
Practice Address - Phone:202-578-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide