Healthcare Provider Details

I. General information

NPI: 1336078807
Provider Name (Legal Business Name): FAITH ALIVIA HARTZOG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 13TH PL SE APT 302
WASHINGTON DC
20032-5031
US

IV. Provider business mailing address

3406 13TH PL SE APT 302
WASHINGTON DC
20032-5031
US

V. Phone/Fax

Practice location:
  • Phone: 240-633-0261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: