Healthcare Provider Details

I. General information

NPI: 1609733187
Provider Name (Legal Business Name): MICHAEL TYREK LONG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 IRVING ST NW
WASHINGTON DC
20010-2312
US

IV. Provider business mailing address

1410 DELAFIELD PL NW
WASHINGTON DC
20011-4347
US

V. Phone/Fax

Practice location:
  • Phone: 202-883-9751
  • Fax:
Mailing address:
  • Phone: 202-860-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: