MEDICARE: LILY HABTOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	HHA200005738	DC

General Provider Information

NPI Number	:	1205799699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY HABTOM

Provider Business Mailing Address
First Line	:	36 HAWAII AVE NE # 2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-4984
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6475 NEW HAMPSHIRE AVE
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20783-3269
Country	:	US
Telephone Number	:	202-361-8464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ LILY HABTOM ” Practice Location

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