Provider Demographics
NPI:1720358351
Name:EB REALITY LLC
Entity Type:Organization
Organization Name:EB REALITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BISRAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILEMESKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-460-7060
Mailing Address - Street 1:13208 BELLEVUE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1703
Mailing Address - Country:US
Mailing Address - Phone:240-460-7060
Mailing Address - Fax:888-725-2751
Practice Address - Street 1:731 KENNEDY STREET, NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:240-460-7060
Practice Address - Fax:888-725-2751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care