Healthcare Provider Details

I. General information

NPI: 1205799699
Provider Name (Legal Business Name): LILY HABTOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 NEW HAMPSHIRE AVE
HYATTSVILLE MD
20783-3269
US

IV. Provider business mailing address

36 HAWAII AVE NE # 2
WASHINGTON DC
20011-4984
US

V. Phone/Fax

Practice location:
  • Phone: 202-361-8464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005738
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: