Individual ProviderEboni R BaconCase Manager/Care CoordinatorOther Service ProvidersPractice Address3300 Pennsylvania Ave SE, Washington, DC 20020-2408(202) 878-6626(301) 252-4253PECOS EnrollmentBased on the most recent information from CMS, provider Eboni R Bacon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:04 AM.Profile DetailsProvider ID1265132203Provider TypeIndividualFull NameBacon, Eboni RGenderFemaleSole ProprietorYesEnumeration Date3/8/2023Last Updated6/7/2023Contact InformationPractice LocationPractice Address3300 Pennsylvania Ave SE, Washington, DC 20020-2408Phone(202) 878-6626FaxUnlisted FaxMailing LocationMailing Address18474 Brooke Rd, Sandy Spring, MD 20860-1406Phone(301) 252-4253FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerCode172V00000XDescriptionCommunity Health WorkerOther Service ProvidersLicenseUnlisted IssuerCode251S00000XDescriptionCommunity/Behavioral HealthAgenciesLicenseUnlisted Issuer