Healthcare Provider Details

I. General information

NPI: 1679333926
Provider Name (Legal Business Name): BETRAND ANUBONDEM BEZALEKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW # 360
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

8905 ROYAL CREST DR
HYATTSVILLE MD
20783-2049
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8494
  • Fax:
Mailing address:
  • Phone: 231-327-1804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200003225
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: