Provider Demographics
NPI:1841014503
Name:JAITEH, EBONY (HOME CARE AIDE)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:JAITEH
Suffix:
Gender:F
Credentials:HOME CARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 W MISSION AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2837
Mailing Address - Country:US
Mailing Address - Phone:414-698-4649
Mailing Address - Fax:
Practice Address - Street 1:1829 W MISSION AVE UNIT A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2837
Practice Address - Country:US
Practice Address - Phone:414-698-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61501640374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide