Healthcare Provider Details

I. General information

NPI: 1497019020
Provider Name (Legal Business Name): ELENI GEBEREGZEHABHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2012
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 THOMAS JEFFERSON ST NW STE 180G
WASHINGTON DC
20007
US

IV. Provider business mailing address

1025 THOMAS JEFFERSON ST NW STE 180G
WASHINGTON DC
20007-5209
US

V. Phone/Fax

Practice location:
  • Phone: 202-299-1109
  • Fax: 202-299-1108
Mailing address:
  • Phone: 202-299-1109
  • Fax: 202-299-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA0768
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: