Healthcare Provider Details

I. General information

NPI: 1215528039
Provider Name (Legal Business Name): ETHIOPIA MINAL LEGESSE HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW STE LL16
WASHINGTON DC
20012-1328
US

IV. Provider business mailing address

666 HOUSTON AVE APT 409
SILVER SPRING MD
20912-6294
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-1100
  • Fax: 202-723-3271
Mailing address:
  • Phone: 202-790-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: