Healthcare Provider Details

I. General information

NPI: 1760134191
Provider Name (Legal Business Name): CENTRAL CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 CENTRAL AVE NE
WASHINGTON DC
20018-2624
US

IV. Provider business mailing address

3218 CENTRAL AVE NE
WASHINGTON DC
20018-2624
US

V. Phone/Fax

Practice location:
  • Phone: 202-636-3801
  • Fax: 866-636-2655
Mailing address:
  • Phone: 202-636-3801
  • Fax: 866-636-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. LISA A EDWARDS
Title or Position: PRESIDENT/DIRECTING MANAGER
Credential:
Phone: 202-636-3801