Healthcare Provider Details

I. General information

NPI: 1063836658
Provider Name (Legal Business Name): SELOME GIMITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 14TH ST NW APT 305
WASHINGTON DC
20005-3629
US

IV. Provider business mailing address

820 UPSHUR ST NW
WASHINGTON DC
20011-5837
US

V. Phone/Fax

Practice location:
  • Phone: 240-883-1576
  • Fax:
Mailing address:
  • Phone: 202-723-0304
  • Fax: 202-723-0367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: