Provider Demographics
NPI:1114386901
Name:ETHIO HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:ETHIO HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILEYESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-320-2382
Mailing Address - Street 1:545 CONCORD AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1125
Mailing Address - Country:US
Mailing Address - Phone:617-955-0629
Mailing Address - Fax:
Practice Address - Street 1:545 CONCORD AVE
Practice Address - Street 2:STE 6
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1125
Practice Address - Country:US
Practice Address - Phone:617-955-0629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health