Provider Demographics
NPI:1326757543
Name:A1CARE
Entity Type:Organization
Organization Name:A1CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEEROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MBUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-817-9630
Mailing Address - Street 1:1420 N ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-2876
Mailing Address - Country:US
Mailing Address - Phone:202-817-9630
Mailing Address - Fax:
Practice Address - Street 1:1420 N ST NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-2876
Practice Address - Country:US
Practice Address - Phone:202-817-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC00Medicaid