Provider Demographics
NPI:1104382019
Name:BALCHA, FASIKA SEBSIBE
Entity Type:Individual
Prefix:
First Name:FASIKA
Middle Name:SEBSIBE
Last Name:BALCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 16TH ST APT 322
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5919
Mailing Address - Country:US
Mailing Address - Phone:240-350-5033
Mailing Address - Fax:
Practice Address - Street 1:8508 16TH ST APT 322
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5919
Practice Address - Country:US
Practice Address - Phone:240-350-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14300374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide