Provider Demographics
NPI:1205655222
Name:HAILE, TESHOME ABATE (PROVIDER)
Entity type:Individual
Prefix:
First Name:TESHOME
Middle Name:ABATE
Last Name:HAILE
Suffix:
Gender:M
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 127TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-5580
Mailing Address - Country:US
Mailing Address - Phone:425-355-5159
Mailing Address - Fax:360-386-9890
Practice Address - Street 1:2117 127TH PL SW
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-5580
Practice Address - Country:US
Practice Address - Phone:425-355-5159
Practice Address - Fax:360-386-9890
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA751102311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home