Healthcare Provider Details

I. General information

NPI: 1063290229
Provider Name (Legal Business Name): ROLAND CABREL SIMEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9803 GOOD LUCK RD
LANHAM MD
20706-3353
US

IV. Provider business mailing address

2906 PUMPKIN ST
CLINTON MD
20735-1068
US

V. Phone/Fax

Practice location:
  • Phone: 240-474-7397
  • Fax:
Mailing address:
  • Phone: 240-474-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: