=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972026532
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOSEF TEREFE KEBEDE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2017
-----------------------------------------------------
Last Update Date | 07/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 824 UPSHUR ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-5837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-723-0755
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 705 STIRLING RD # MD
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20901-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-461-8881
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HHA12837
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------