Healthcare Provider Details

I. General information

NPI: 1972346005
Provider Name (Legal Business Name): MD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DONNINGTON ST
PUEBLO CO
81005-5529
US

IV. Provider business mailing address

1642 S PARKER RD STE 105
DENVER CO
80231-2918
US

V. Phone/Fax

Practice location:
  • Phone: 720-324-1989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MOSAAB DAWLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-324-1989