Provider Demographics
NPI:1457627135
Name:ACHIDI, CONRAD (HHA)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:
Last Name:ACHIDI
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 LONGFELLOW ST NW
Mailing Address - Street 2:APT 310
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3081
Mailing Address - Country:US
Mailing Address - Phone:202-718-8289
Mailing Address - Fax:
Practice Address - Street 1:1707 L ST NW
Practice Address - Street 2:SUITE 900
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4201
Practice Address - Country:US
Practice Address - Phone:202-829-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide