Healthcare Provider Details

I. General information

NPI: 1952078818
Provider Name (Legal Business Name): HOUSE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 CARONA CT
SILVER SPRING MD
20905-7443
US

IV. Provider business mailing address

94 CARONA CT
SILVER SPRING MD
20905-7443
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-4586
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MIGUEL LIONEL DJONTU
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-821-4586