Healthcare Provider Details

I. General information

NPI: 1740810985
Provider Name (Legal Business Name): COVERED CARE HAIR LOSS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ALLENTOWN ROAD SUITE 304
CAMP SPRINGS MD
20746
US

IV. Provider business mailing address

5801 ALLENTOWN ROAD SUITE 304
CAMP SPRINGS MD
20746
US

V. Phone/Fax

Practice location:
  • Phone: 301-453-5955
  • Fax:
Mailing address:
  • Phone: 301-453-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: TASHIEK HAWKINS
Title or Position: OWNER
Credential:
Phone: 301-453-5955