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General NPI Number Information
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NPI Number | 1801402656
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Entity Type | Organization
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Legal Business Name | DESICARE LLC
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 3200 CRAIN HWY STE 300
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City | WALDORF
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State | MD
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Zip | 20603-4843
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Country | US
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Telephone | 301-852-4540
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Fax | 240-427-9274
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Provider Business Mailing Address
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Address Line | 4157 MOUNTAIN ROAD 160
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City | PASADENA
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State | MD
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Zip | 21122
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Country | US
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Telephone | 470-263-0801
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CHERYL MICHELE JONES
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Credential |
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Telephone | 301-768-7122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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