Healthcare Provider Details

I. General information

NPI: 1821475682
Provider Name (Legal Business Name): MARYLAND CARE OF CAMP SPRINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4703 OLD SOPER ROAD SUITE R-1
CAMP SPRINGS MD
20746
US

IV. Provider business mailing address

4703 OLD SOPER ROAD SUITE R-1
CAMP SPRINGS MD
20746
US

V. Phone/Fax

Practice location:
  • Phone: 240-716-3649
  • Fax: 240-716-3672
Mailing address:
  • Phone: 240-716-3649
  • Fax: 240-427-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number16008A
License Number StateMD

VIII. Authorized Official

Name: MRS. KHANH-LINH FLYNN
Title or Position: MANAGING PARTNER
Credential:
Phone: 240-716-3649