Healthcare Provider Details

I. General information

NPI: 1699555193
Provider Name (Legal Business Name): TSEHAYNESH ASSEFA GEBREKERISTOS HHA CERTIFICATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 BALFOUR DR
HYATTSVILLE MD
20782-1504
US

IV. Provider business mailing address

6111 BALFOUR DR
HYATTSVILLE MD
20782-1504
US

V. Phone/Fax

Practice location:
  • Phone: 301-679-8367
  • Fax:
Mailing address:
  • Phone: 301-679-8367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number200002896
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: