Healthcare Provider Details

I. General information

NPI: 1144581430
Provider Name (Legal Business Name): CORPORAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2012
Last Update Date: 06/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 W VIRGINIA AVE NE APT 4
WASHINGTON DC
20002-2346
US

IV. Provider business mailing address

1721 W VIRGINIA AVE NE APT 4
WASHINGTON DC
20002-2346
US

V. Phone/Fax

Practice location:
  • Phone: 703-568-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH NDEH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 703-568-4888