Provider Demographics
NPI:1982028502
Name:DC CARES CENTER, INC.
Entity Type:Organization
Organization Name:DC CARES CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALIK
Authorized Official - Middle Name:ZULU
Authorized Official - Last Name:SHABAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-369-9986
Mailing Address - Street 1:4043 CLAY PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-3340
Mailing Address - Country:US
Mailing Address - Phone:202-369-9986
Mailing Address - Fax:202-269-4159
Practice Address - Street 1:61 HAWAII AVE NE
Practice Address - Street 2:SUITE LL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-4985
Practice Address - Country:US
Practice Address - Phone:202-269-2736
Practice Address - Fax:202-269-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC69000761385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039903300Medicaid