MEDICARE: MRS. JENNIFER RIVAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1114284130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER RIVAS

Provider Business Mailing Address
First Line	:	3500 18TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2738
Country	:	US
Telephone Number	:	202-529-6510
Fax Number	:	202-529-6570

Provider Business Practice Location Address
First Line	:	3500 18TH ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-2738
Country	:	US
Telephone Number	:	202-529-6510
Fax Number	:	202-529-6570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2012
Last Update Date	:	04/15/2012

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