1659348944 NPI number — RELIABLE CARE LLC

Table of content: (NPI 1659348944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659348944 NPI number — RELIABLE CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RELIABLE CARE 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:
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:
1659348944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 QUINCE ORCHARD BLVD STE H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-1683
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-947-9545
Provider Business Mailing Address Fax Number:
301-947-9548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
849 QUINCE ORCHARD BLVD STE H
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20878-1683
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-947-9545
Provider Business Practice Location Address Fax Number:
301-947-9548
Provider Enumeration Date:
03/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NWEKE
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
301-947-9545

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R2139 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: R2292 , 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: 237301 . This is a "AMERIGROUP - VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 400250400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 520077 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 403679400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 627717 . This is a "NCPPO - HOME CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 237301 . This is a "AMERIGROUP -MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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