MEDICARE: MONTCARE SERVICES

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	253Z00000X	In Home Supportive Care Agency		MD

General Provider Information

NPI Number	:	1871913806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTCARE SERVICES

Provider Business Mailing Address
First Line	:	9812 LAKE POINTE CT
Second Line	:	UNIT 1
City	:	LARGO
State	:	MD
Zip	:	20774-4719
Country	:	US
Telephone Number	:	240-292-0270
Fax Number	:

Provider Business Practice Location Address
First Line	:	9812 LAKE POINTE CT
Second Line	:	UNIT 1
City	:	LARGO
State	:	MD
Zip	:	20774-4719
Country	:	US
Telephone Number	:	240-292-0270
Fax Number	:

Authorized Official
Title or Position	:	MANAGING OWNER
Name	:	TAEKO CLARK
Credential	:	6463300272
Telephone Number	:	240-292-0270

Provider Enumeration Date	:	04/17/2014
Last Update Date	:	04/17/2014

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