Provider Demographics
NPI:1326716044
Name:SELBON CARE INC
Entity Type:Organization
Organization Name:SELBON CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-437-0443
Mailing Address - Street 1:15609 HEXHAM TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-8024
Mailing Address - Country:US
Mailing Address - Phone:301-437-0443
Mailing Address - Fax:
Practice Address - Street 1:15609 HEXHAM TER
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-8024
Practice Address - Country:US
Practice Address - Phone:301-437-0443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services