Healthcare Provider Details

I. General information

NPI: 1053177725
Provider Name (Legal Business Name): ACCESS CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20528 BOLAND FARM RD STE 204
GERMANTOWN MD
20876-4038
US

IV. Provider business mailing address

20528 BOLAND FARM RD STE 204
GERMANTOWN MD
20876-4038
US

V. Phone/Fax

Practice location:
  • Phone: 401-829-2654
  • Fax:
Mailing address:
  • Phone: 301-778-1415
  • Fax: 301-778-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DIANA CHEKRALLAH
Title or Position: OWNER
Credential: MS
Phone: 401-829-2654