Provider Demographics
NPI:1558028324
Name:ADDIS HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ADDIS HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEDHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBREAMLAK
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:703-732-7126
Mailing Address - Street 1:8072 HORSESHOE COTTAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2327
Mailing Address - Country:US
Mailing Address - Phone:301-477-4916
Mailing Address - Fax:
Practice Address - Street 1:7835 BELLE POINT DR
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3338
Practice Address - Country:US
Practice Address - Phone:301-477-4916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty