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General NPI Number Information
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NPI Number | 1396202511
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Entity Type | Organization
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Legal Business Name | SPRAOUT CARE LLC
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 7603 GEORGIA AVE NW STE 204
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City | WASHINGTON
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State | DC
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Zip | 20012-1617
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Country | US
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Telephone | 202-601-5310
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Fax |
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Provider Business Mailing Address
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Address Line | 7603 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20012-1617
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Country | US
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Telephone | 240-350-9677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FIDELIS N SAB
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Credential | CAC II
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Telephone | 240-350-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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