Healthcare Provider Details

I. General information

NPI: 1518803089
Provider Name (Legal Business Name): COMMUNITY CARE DEVELOPMENTAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 15TH ST NW APT 32
WASHINGTON DC
20009-3924
US

IV. Provider business mailing address

1905 15TH ST NW APT 32
WASHINGTON DC
20009-3924
US

V. Phone/Fax

Practice location:
  • Phone: 443-418-8669
  • Fax:
Mailing address:
  • Phone: 443-418-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JANUARY LEVERE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 443-418-8669