Provider Demographics
NPI:1114446762
Name:QUALICARE MEDICAL SUPPLIES LLC
Entity Type:Organization
Organization Name:QUALICARE MEDICAL SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVERNE
Authorized Official - Middle Name:SYLVIA
Authorized Official - Last Name:CEPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-577-4077
Mailing Address - Street 1:9320 ANNAPOLIS RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3165
Mailing Address - Country:US
Mailing Address - Phone:301-577-4077
Mailing Address - Fax:301-577-4577
Practice Address - Street 1:9320 ANNAPOLIS RD STE 210
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706
Practice Address - Country:US
Practice Address - Phone:301-577-4077
Practice Address - Fax:301-577-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD290017300Medicaid