Provider Demographics
NPI:1346091949
Name:WORKNEH, MENELIK BELETE
Entity Type:Individual
Prefix:
First Name:MENELIK
Middle Name:BELETE
Last Name:WORKNEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8215 NE 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0111
Mailing Address - Country:US
Mailing Address - Phone:360-952-1508
Mailing Address - Fax:360-314-4942
Practice Address - Street 1:8215 NE 29TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0111
Practice Address - Country:US
Practice Address - Phone:360-952-1508
Practice Address - Fax:360-314-4942
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA605140309311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home