Provider Demographics
NPI:1790268555
Name:BEBEH, MAGRESTINE MEMEH
Entity Type:Individual
Prefix:
First Name:MAGRESTINE
Middle Name:MEMEH
Last Name:BEBEH
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 1:5249 KENILWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-2863
Mailing Address - Country:US
Mailing Address - Phone:443-458-3302
Mailing Address - Fax:
Practice Address - Street 1:5249 KENILWORTH AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-2863
Practice Address - Country:US
Practice Address - Phone:443-458-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13957374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide