Healthcare Provider Details

I. General information

NPI: 1366156911
Provider Name (Legal Business Name): UNCONDITIONAL CARE ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 ECHODALE AVE
BALTIMORE MD
21214-2619
US

IV. Provider business mailing address

3200 ECHODALE AVE
BALTIMORE MD
21214-2619
US

V. Phone/Fax

Practice location:
  • Phone: 202-870-2916
  • Fax:
Mailing address:
  • Phone: 202-870-2916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: COURTNEY WIGGINS
Title or Position: OWNER
Credential:
Phone: 202-870-2916