Healthcare Provider Details

I. General information

NPI: 1790338903
Provider Name (Legal Business Name): RUTH ABEBE YIMENU HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11612 STEWART LN APT 302
SILVER SPRING MD
20904-2458
US

IV. Provider business mailing address

11612 STEWART LN APT 302
SILVER SPRING MD
20904-2458
US

V. Phone/Fax

Practice location:
  • Phone: 240-665-2360
  • Fax:
Mailing address:
  • Phone: 240-665-2360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA14552
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: