Provider Demographics
NPI:1306307558
Name:LECHEDEM, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LECHEDEM
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 1:5120 SARGENT RD NE APT 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2830
Mailing Address - Country:US
Mailing Address - Phone:202-751-7055
Mailing Address - Fax:
Practice Address - Street 1:5120 SARGENT RD NE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2830
Practice Address - Country:US
Practice Address - Phone:202-751-7055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide