=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669228904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2024
-----------------------------------------------------
Last Update Date | 04/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2000 RHODE ISLAND AVE NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20018-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-342-4658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2000 RHODE ISLAND AVE NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20018-2835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-342-4658
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CTO
-----------------------------------------------------
Name | MR. NINON LONTSI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-929-9466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------