Healthcare Provider Details

I. General information

NPI: 1134051949
Provider Name (Legal Business Name): HALEFOM KALAYU HADGU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RHODE ISLAND AVE NE
WASHINGTON DC
20018-2835
US

IV. Provider business mailing address

1221 VAN BUREN ST NW APT 103A
WASHINGTON DC
20012-2935
US

V. Phone/Fax

Practice location:
  • Phone: 202-526-3535
  • Fax:
Mailing address:
  • Phone: 202-702-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberHHA200006262
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: