Healthcare Provider Details

I. General information

NPI: 1528318433
Provider Name (Legal Business Name): BRENDA LEE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRENDA LEE THOMAS HOME HEALTH AIDE

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 RHODE ISLAND AVE NE.
WASHINGTON DC
20018-1937
US

IV. Provider business mailing address

1335 SARATOGA AVE NE APT 1
WASHINGTON DC
20018-1937
US

V. Phone/Fax

Practice location:
  • Phone: 202-635-6006
  • Fax: 202-636-1936
Mailing address:
  • Phone: 202-455-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: