Provider Demographics
NPI:1336695600
Name:COREWOOD CARE LLC
Entity Type:Organization
Organization Name:COREWOOD CARE LLC
Other - Org Name:COREWOOD HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'DONOGHUE
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:301-909-8117
Mailing Address - Street 1:5425 WISCONSIN AVENUE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:301-706-7675
Mailing Address - Fax:
Practice Address - Street 1:4701 SANGAMORE RD STE S225
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816
Practice Address - Country:US
Practice Address - Phone:301-909-8117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3911253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care