Healthcare Provider Details

I. General information

NPI: 1245910132
Provider Name (Legal Business Name): AZURE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 APOLLO DR STE 100
UPPER MARLBORO MD
20774-4785
US

IV. Provider business mailing address

9701 APOLLO DR STE 100
UPPER MARLBORO MD
20774-4785
US

V. Phone/Fax

Practice location:
  • Phone: 844-429-8732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLIENT SERVICES
Title or Position: CLIENT SERVICES
Credential:
Phone: 844-429-8732