Provider Demographics
NPI:1366589509
Name:TRISTATE HOME HEALTH & EQUIPMENT
Entity type:Organization
Organization Name:TRISTATE HOME HEALTH & EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AWASUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-462-5401
Mailing Address - Street 1:6210 CHILLUM PL NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-1400
Mailing Address - Country:US
Mailing Address - Phone:202-462-5401
Mailing Address - Fax:202-462-5402
Practice Address - Street 1:6210 CHILLUM PL NW
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1400
Practice Address - Country:US
Practice Address - Phone:202-462-5401
Practice Address - Fax:202-462-5402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035783700Medicaid
DC026429800Medicaid
DC035783700Medicaid