Healthcare Provider Details

I. General information

NPI: 1740822345
Provider Name (Legal Business Name): GENET K WOLDEGEBRIEL HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 EASTERN AVE NW
WASHINGTON DC
20012-1324
US

IV. Provider business mailing address

7826 EASTERN AVE NW
WASHINGTON DC
20012-1324
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-1100
  • Fax: 202-723-0359
Mailing address:
  • Phone: 202-723-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14704
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: