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General NPI Number Information
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NPI Number | 1720358351
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Entity Type | Organization
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Legal Business Name | EB REALITY LLC
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 731 KENNEDY STREET, NW
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City | WASHINGTON
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State | DC
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Zip | 20011
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Country | US
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Telephone | 240-460-7060
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Fax | 888-725-2751
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Provider Business Mailing Address
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Address Line | 13208 BELLEVUE ST
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City | SILVER SPRING
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State | MD
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Zip | 20904-1703
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Country | US
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Telephone | 240-460-7060
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Fax | 888-725-2751
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. BISRAT HAILEMESKEL
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Credential |
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Telephone | 240-460-7060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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