Healthcare Provider Details

I. General information

NPI: 1205105830
Provider Name (Legal Business Name): GRACE EMMANUEL LIVINGSTON HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNICE GASSOP LEVESTINE TOUKAM HHA

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 106
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

11235 OAK LEAF DR 703
SILVER SPRING MD
20901
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone: 240-386-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: