Healthcare Provider Details

I. General information

NPI: 1760209142
Provider Name (Legal Business Name): QUICK CARE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 LIBERTY RD STE C
WINDSOR MILL MD
21244-3021
US

IV. Provider business mailing address

8136 LIBERTY RD STE C
WINDSOR MILL MD
21244-3021
US

V. Phone/Fax

Practice location:
  • Phone: 301-536-0044
  • Fax:
Mailing address:
  • Phone: 301-536-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COLMAN EJERENWA
Title or Position: OWNER
Credential: PMHNP
Phone: 301-536-0044