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General NPI Number Information
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NPI Number | 1689437675
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Entity Type | Individual
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Provider Name | JEREMIAH MANSARAY
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Gender | Male
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 2811 PENNSYLVANIA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-3865
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Country | US
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Telephone | 202-894-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 780 FAIRVIEW AVE
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City | TAKOMA PARK
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State | MD
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Zip | 20912-5978
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Country | US
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Telephone | 240-595-7547
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | HHA200004941
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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