Healthcare Provider Details

I. General information

NPI: 1578491262
Provider Name (Legal Business Name): BRIZIL TICHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E WEST HWY
RIVERDALE MD
20737-1028
US

IV. Provider business mailing address

4601 E WEST HWY
RIVERDALE MD
20737-1028
US

V. Phone/Fax

Practice location:
  • Phone: 701-215-0732
  • Fax:
Mailing address:
  • Phone: 701-215-0732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA200005073
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: