Healthcare Provider Details

I. General information

NPI: 1437825270
Provider Name (Legal Business Name): FIRST CARE FAMILY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237A CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

IV. Provider business mailing address

3237A CORPORATE CT
ELLICOTT CITY MD
21042-2247
US

V. Phone/Fax

Practice location:
  • Phone: 410-680-8354
  • Fax: 443-592-9057
Mailing address:
  • Phone: 410-680-8354
  • Fax: 443-592-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ADETOLA O OYEKAN
Title or Position: OWNER
Credential:
Phone: 240-838-1297