Healthcare Provider Details

I. General information

NPI: 1922762954
Provider Name (Legal Business Name): YEMESERACH DESSALEGN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 10/26/2021
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 PATTERSON AVE APT 25
RICHMOND VA
23229-6183
US

IV. Provider business mailing address

9001 PATTERSON AVE APT 25
RICHMOND VA
23229-6183
US

V. Phone/Fax

Practice location:
  • Phone: 917-415-1789
  • Fax:
Mailing address:
  • Phone: 917-415-1789
  • 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: YEMESERACH DESSALEGN
Title or Position: OWNER
Credential:
Phone: 917-415-1789