Provider Demographics
NPI:1922762954
Name:YEMESERACH DESSALEGN
Entity Type:Organization
Organization Name:YEMESERACH DESSALEGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEMESERACH
Authorized Official - Middle Name:
Authorized Official - Last Name:DESSALEGN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-415-1789
Mailing Address - Street 1:9001 PATTERSON AVE APT 25
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-6183
Mailing Address - Country:US
Mailing Address - Phone:917-415-1789
Mailing Address - Fax:
Practice Address - Street 1:9001 PATTERSON AVE APT 25
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6183
Practice Address - Country:US
Practice Address - Phone:917-415-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)