Provider Demographics
NPI:1700261302
Name:MEDTECHCARESYSTEMS LLC
Entity Type:Organization
Organization Name:MEDTECHCARESYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DICK
Authorized Official - Last Name:NDIKUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-603-8579
Mailing Address - Street 1:3200 HOLLY BERRY CT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3315
Mailing Address - Country:US
Mailing Address - Phone:703-846-0312
Mailing Address - Fax:
Practice Address - Street 1:3200 HOLLY BERRY CT
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3315
Practice Address - Country:US
Practice Address - Phone:703-846-0312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA320600000X
VA320600000320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities