Provider Demographics
NPI:1508647975
Name:GEBREYESUS, TADESSE TEKLU (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:
First Name:TADESSE
Middle Name:TEKLU
Last Name:GEBREYESUS
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1249
Mailing Address - Country:US
Mailing Address - Phone:614-332-6136
Mailing Address - Fax:
Practice Address - Street 1:76 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-1249
Practice Address - Country:US
Practice Address - Phone:614-332-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651757376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty