Provider Demographics
NPI:1467208272
Name:HAILE, BIRKE TADESSE
Entity type:Individual
Prefix:
First Name:BIRKE
Middle Name:TADESSE
Last Name:HAILE
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 1:909 LONGFELLOW ST NW APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-8245
Mailing Address - Country:US
Mailing Address - Phone:202-652-5515
Mailing Address - Fax:
Practice Address - Street 1:909 LONGFELLOW ST NW APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-8245
Practice Address - Country:US
Practice Address - Phone:202-652-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003683374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide