Healthcare Provider Details

I. General information

NPI: 1558274571
Provider Name (Legal Business Name): HIBISCUS CARE HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HIBISCUS LN
CAMBRIDGE MD
21613-3044
US

IV. Provider business mailing address

209 HIBISCUS LN
CAMBRIDGE MD
21613-3044
US

V. Phone/Fax

Practice location:
  • Phone: 443-876-5377
  • Fax:
Mailing address:
  • Phone: 443-876-5377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: SHARRON WHITAKER
Title or Position: OWNER
Credential:
Phone: 443-876-5377