Healthcare Provider Details

I. General information

NPI: 1912833898
Provider Name (Legal Business Name): EBONY CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MLK JR AVE SW APT A613
WASHINGTON DC
20032-4885
US

IV. Provider business mailing address

4317 DANVILLE RD
BRANDYWINE MD
20613-9281
US

V. Phone/Fax

Practice location:
  • Phone: 202-684-1030
  • Fax:
Mailing address:
  • Phone: 202-394-2450
  • 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: