MEDICARE: MIRABEL CHE ATEH HHA

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	HHA13185	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HHA13185	OTHER	DC	HEALTH REGULATION AND LICENSING ADMINISTRATION BOARD OF NURSING
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841701067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRABEL CHE ATEH HHA

Provider Business Mailing Address
First Line	:	7831 RIVERDALE RD APT 303
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4016
Country	:	US
Telephone Number	:	240-581-2134
Fax Number	:

Provider Business Practice Location Address
First Line	:	7831 RIVERDALE RD APT 303
Second Line	:
City	:	NEW CARROLLTON
State	:	MD
Zip	:	20784-4016
Country	:	US
Telephone Number	:	240-581-2134
Fax Number	:

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

Provider Enumeration Date	:	10/15/2017
Last Update Date	:	10/15/2017

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