Provider Demographics
NPI:1699555193
Name:GEBREKERISTOS, TSEHAYNESH ASSEFA (HHA CERTIFICATE)
Entity type:Individual
Prefix:
First Name:TSEHAYNESH
Middle Name:ASSEFA
Last Name:GEBREKERISTOS
Suffix:
Gender:F
Credentials:HHA CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1504
Mailing Address - Country:US
Mailing Address - Phone:301-679-8367
Mailing Address - Fax:
Practice Address - Street 1:6111 BALFOUR DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-1504
Practice Address - Country:US
Practice Address - Phone:301-679-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC200002896374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide