Healthcare Provider Details

I. General information

NPI: 1730687849
Provider Name (Legal Business Name): RUTH BIRHANU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

1301 14TH ST NW APT 305
WASHINGTON DC
20005-3629
US

V. Phone/Fax

Practice location:
  • Phone: 202-506-1209
  • Fax:
Mailing address:
  • Phone: 202-841-7618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA13179
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: