Healthcare Provider Details

I. General information

NPI: 1669210209
Provider Name (Legal Business Name): JAROMA DISTINCT CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15800 PERKINS LN
BOWIE MD
20716-1641
US

IV. Provider business mailing address

15800 PERKINS LN
BOWIE MD
20716-1641
US

V. Phone/Fax

Practice location:
  • Phone: 240-929-4276
  • Fax: 240-334-2851
Mailing address:
  • Phone: 240-929-4276
  • Fax: 240-334-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: RITA EMANKWA ELAD
Title or Position: OWNER
Credential: RN
Phone: 240-550-3685