1770160251 NPI number — NATURECARE INC

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 1770160251 NPI number — NATURECARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATURECARE 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:
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:
1770160251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 WINELEAF CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCKEYSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21030-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-823-3350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REISTERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21136-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-833-9844
Provider Business Practice Location Address Fax Number:
410-833-9845
Provider Enumeration Date:
03/29/2021

Additional Information

Authorized Official

Authorized Official Last Name:
POTLURI
Authorized Official First Name:
SYAM
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
443-823-3350

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 226610500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com