Healthcare Provider Details

I. General information

NPI: 1144192998
Provider Name (Legal Business Name): KIRSTIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ALLENTOWN RD STE 310
CAMP SPRINGS MD
20746-4564
US

IV. Provider business mailing address

5801 ALLENTOWN RD STE 310
CAMP SPRINGS MD
20746-4564
US

V. Phone/Fax

Practice location:
  • Phone: 392-240-2876
  • Fax:
Mailing address:
  • Phone: 392-240-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN FONCHAM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 240-354-4444