1578749420 NPI number — CENTRAL CARE MEDICAL SUPPLIES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578749420 NPI number — CENTRAL CARE MEDICAL SUPPLIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL CARE MEDICAL SUPPLIES, LLC
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:
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:
1578749420
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3218 CENTRAL AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20018-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-391-5024
Provider Business Mailing Address Fax Number:
866-261-0478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9244 E HAMPTON DR
Provider Second Line Business Practice Location Address:
631
Provider Business Practice Location Address City Name:
CAPITOL HEIGHTS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20743-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-585-6704
Provider Business Practice Location Address Fax Number:
866-261-0478
Provider Enumeration Date:
01/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
866-585-6704

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  R2586 , 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: 017398300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com