Healthcare Provider Details

I. General information

NPI: 1720358351
Provider Name (Legal Business Name): EB REALITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 01/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 KENNEDY STREET, NW
WASHINGTON DC
20011
US

IV. Provider business mailing address

13208 BELLEVUE ST
SILVER SPRING MD
20904-1703
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-7060
  • Fax: 888-725-2751
Mailing address:
  • Phone: 240-460-7060
  • Fax: 888-725-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: DR. BISRAT HAILEMESKEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 240-460-7060