Provider Demographics
NPI:1578749420
Name:CENTRAL CARE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:CENTRAL CARE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-585-6704
Mailing Address - Street 1:3218 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2624
Mailing Address - Country:US
Mailing Address - Phone:202-391-5024
Mailing Address - Fax:866-261-0478
Practice Address - Street 1:9244 E HAMPTON DR
Practice Address - Street 2:631
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3858
Practice Address - Country:US
Practice Address - Phone:866-585-6704
Practice Address - Fax:866-261-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2586332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD017398300Medicaid
MD017398300Medicaid