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General NPI Number Information
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NPI Number | 1336695600
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Entity Type | Organization
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Legal Business Name | COREWOOD CARE LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 06/11/2018
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Provider Practice Location Address
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Address Line | 4701 SANGAMORE RD STE S225
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City | BETHESDA
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State | MD
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Zip | 20816
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Country | US
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Telephone | 301-909-8117
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Fax |
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Provider Business Mailing Address
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Address Line | 5425 WISCONSIN AVENUE SUITE 600
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City | CHEVY CHASE
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State | MD
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Zip | 20815
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Country | US
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Telephone | 301-706-7675
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. MARY C O'DONOGHUE
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Credential | JD
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Telephone | 301-909-8117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | R3911
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License Number State | MD
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