Healthcare Provider Details

I. General information

NPI: 1366850885
Provider Name (Legal Business Name): IYESHIA ANDERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 44TH ST NE
WASHINGTON DC
20019-8044
US

IV. Provider business mailing address

500 44TH ST NE
WASHINGTON DC
20019-8044
US

V. Phone/Fax

Practice location:
  • Phone: 202-446-6694
  • Fax:
Mailing address:
  • Phone: 202-446-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberHHA10058
License Number StateDC

VIII. Authorized Official

Name: IYESHIA ANDERSON
Title or Position: HOME HEALTH AIDE
Credential:
Phone: 202-446-6694