Healthcare Provider Details

I. General information

NPI: 1770713372
Provider Name (Legal Business Name): LACARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 SYRIA CT
FORT WASHINGTON MD
20744-5932
US

IV. Provider business mailing address

308 SYRIA CT
FORT WASHINGTON MD
20744-5932
US

V. Phone/Fax

Practice location:
  • Phone: 443-880-7600
  • Fax: 240-493-6057
Mailing address:
  • Phone: 443-880-7600
  • Fax: 240-493-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EVELYN CHINYELU ONYEOZILI
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 443-880-7600