Healthcare Provider Details

I. General information

NPI: 1487911046
Provider Name (Legal Business Name): ADDIS A DELELEGN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 ROCK CREEK FORD RD NW APT# 209
WASHINGTON DC
20011-1701
US

IV. Provider business mailing address

1440 ROCK CREEK FORD RD NW APT# 209
WASHINGTON DC
20011-1701
US

V. Phone/Fax

Practice location:
  • Phone: 202-722-1725
  • Fax:
Mailing address:
  • Phone:
  • 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: