Provider Demographics
NPI:1497019020
Name:GEBEREGZEHABHAR, ELENI
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:GEBEREGZEHABHAR
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 1:1025 THOMAS JEFFERSON ST NW STE 180G
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-5209
Mailing Address - Country:US
Mailing Address - Phone:202-299-1109
Mailing Address - Fax:202-299-1108
Practice Address - Street 1:1025 THOMAS JEFFERSON ST NW STE 180G
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-299-1109
Practice Address - Fax:202-299-1108
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA0768374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide