MEDICARE: CARE CREST SUPPORT, INC

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1689536682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE CREST SUPPORT, INC

Provider Business Mailing Address
First Line	:	6907 FOUNTAIN PARK DR
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9484
Country	:	US
Telephone Number	:	301-395-5805
Fax Number	:

Provider Business Practice Location Address
First Line	:	6907 FOUNTAIN PARK DR
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9484
Country	:	US
Telephone Number	:	301-395-5805
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	OPEYEMI EBUNOLUWA ELEGBE
Credential	:
Telephone Number	:	301-395-5805

Provider Enumeration Date	:	11/27/2025
Last Update Date	:	11/27/2025

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