Healthcare Provider Details

I. General information

NPI: 1558235085
Provider Name (Legal Business Name): ENKUTATASH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5142 LINCOLN AVE APT 204
ALEXANDRIA VA
22312-1932
US

IV. Provider business mailing address

5142 LINCOLN AVE APT 204
ALEXANDRIA VA
22312-1932
US

V. Phone/Fax

Practice location:
  • Phone: 571-337-1882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MESKEREM ALEMU
Title or Position: OWNER
Credential:
Phone: 571-337-1882