MEDICARE: ONE CARE DC INC

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	251S00000X	Community/Behavioral Health Agency	102617-337	DC

General Provider Information

NPI Number	:	1649769662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE CARE DC INC

Provider Business Mailing Address
First Line	:	1628 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-4706
Country	:	US
Telephone Number	:	202-889-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 GOOD HOPE RD SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-4706
Country	:	US
Telephone Number	:	240-506-9577
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MATUTU NYABANGE
Credential	:
Telephone Number	:	202-889-0800

Provider Enumeration Date	:	05/04/2018
Last Update Date	:	01/30/2019

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