Healthcare Provider Details

I. General information

NPI: 1801166558
Provider Name (Legal Business Name): ELDERCARE OF DAMASCUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26137 RIDGE RD
DAMASCUS MD
20872-1867
US

IV. Provider business mailing address

26137 RIDGE RD
DAMASCUS MD
20872-1867
US

V. Phone/Fax

Practice location:
  • Phone: 301-253-2764
  • Fax: 301-253-9079
Mailing address:
  • Phone: 301-253-2764
  • Fax: 301-253-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL HISEONG CHUNG
Title or Position: CEO
Credential:
Phone: 301-253-2764