Healthcare Provider Details

I. General information

NPI: 1417865759
Provider Name (Legal Business Name): COUNTY CARAVAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 MOUNTAINVIEW DR
OAKLAND MD
21550-7191
US

IV. Provider business mailing address

1248 MOUNTAINVIEW DR
OAKLAND MD
21550-7191
US

V. Phone/Fax

Practice location:
  • Phone: 240-442-5374
  • Fax:
Mailing address:
  • Phone: 240-442-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: CURTIS STEFAN
Title or Position: MANAGER
Credential:
Phone: 240-321-8719