Provider Demographics
NPI:1871151415
Name:HART-BASS, ASIA S
Entity type:Individual
Prefix:
First Name:ASIA
Middle Name:S
Last Name:HART-BASS
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 1:3772 HAYES ST NE APT 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:202-867-0670
Practice Address - Street 1:3505 JAY ST NE APT 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1638
Practice Address - Country:US
Practice Address - Phone:202-423-8468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC3691824Medicaid