Provider Demographics
NPI:1760082408
Name:ANDERSON, CALEB JAHEIM
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:JAHEIM
Last Name:ANDERSON
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 1:3533 A ST SE APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-8352
Mailing Address - Country:US
Mailing Address - Phone:202-471-9858
Mailing Address - Fax:
Practice Address - Street 1:4020 MINNESOTA AVE NE APT 287
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3523
Practice Address - Country:US
Practice Address - Phone:202-910-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant