MEDICARE: SOLIDARITY HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1326821844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLIDARITY HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	3205 WINTER PARK CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 WINTER PARK CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20774-7550
Country	:	US
Telephone Number	:	202-413-6179
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TEKO CLAVET
Credential	:
Telephone Number	:	202-413-6179

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/17/2023

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