1114383304 NPI number — CARERITE TFC INC

Table of content: (NPI 1114383304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114383304 NPI number — CARERITE TFC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARERITE TFC INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114383304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7676 NEW HAMPSHIRE AVE
Provider Second Line Business Mailing Address:
SUITE 330
Provider Business Mailing Address City Name:
TAKOMA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20912-7512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-326-1357
Provider Business Mailing Address Fax Number:
301-408-1828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7676 NEW HAMPSHIRE AVE
Provider Second Line Business Practice Location Address:
SUITE 330
Provider Business Practice Location Address City Name:
TAKOMA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20912-7512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-326-1357
Provider Business Practice Location Address Fax Number:
301-408-1828
Provider Enumeration Date:
01/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BASSEY-AKAMUNE
Authorized Official First Name:
FELICIA
Authorized Official Middle Name:
UDUAK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-326-1357

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  00451 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4239423-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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