Provider Demographics
NPI:1003521378
Name:VIDACARE LLC
Entity Type:Organization
Organization Name:VIDACARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYMAN
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-412-3725
Mailing Address - Street 1:1629 K STREET NW
Mailing Address - Street 2:STE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-1631
Mailing Address - Country:US
Mailing Address - Phone:202-403-2284
Mailing Address - Fax:
Practice Address - Street 1:1629 K STREET NW
Practice Address - Street 2:STE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006
Practice Address - Country:US
Practice Address - Phone:202-403-2284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No253Z00000XAgenciesIn Home Supportive Care