Healthcare Provider Details

I. General information

NPI: 1801402656
Provider Name (Legal Business Name): DESICARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CRAIN HWY STE 300
WALDORF MD
20603-4843
US

IV. Provider business mailing address

4157 MOUNTAIN ROAD 160
PASADENA MD
21122
US

V. Phone/Fax

Practice location:
  • Phone: 301-852-4540
  • Fax: 240-427-9274
Mailing address:
  • Phone: 470-263-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHERYL MICHELE JONES
Title or Position: PRESIDENT/CEO
Credential:
Phone: 301-768-7122