MEDICARE: WITH TENDER CARE WTC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1609659861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITH TENDER CARE WTC LLC

Provider Business Mailing Address
First Line	:	11366 KING GEORGE DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4400
Country	:	US
Telephone Number	:	513-504-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	11366 KING GEORGE DR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20902-4400
Country	:	US
Telephone Number	:	513-504-0495
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DEAULO S WALTON
Credential	:	RN, LNHA
Telephone Number	:	513-504-0495

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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