Provider Demographics
NPI:1871913806
Name:MONTCARE SERVICES
Entity type:Organization
Organization Name:MONTCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAEKO
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:6463300272
Authorized Official - Phone:240-292-0270
Mailing Address - Street 1:9812 LAKE POINTE CT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4719
Mailing Address - Country:US
Mailing Address - Phone:240-292-0270
Mailing Address - Fax:
Practice Address - Street 1:9812 LAKE POINTE CT
Practice Address - Street 2:UNIT 1
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-4719
Practice Address - Country:US
Practice Address - Phone:240-292-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care