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General NPI Number Information
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NPI Number | 1285760199
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE FOR KIDS
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 19703 EXECUTIVE PARK CIR
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City | GERMANTOWN
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State | MD
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Zip | 20874-2639
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Country | US
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Telephone | 301-540-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 19703 EXECUTIVE PARK CIR
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City | GERMANTOWN
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State | MD
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Zip | 20874-2639
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Country | US
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Telephone | 301-540-5900
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS KIMBERLY FOSTER
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Credential |
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Telephone | 301-540-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0057921
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | D0055283
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License Number State | MD
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