Life Care Group Home

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

LIFE CARE GROUP HOME

Practice address

14901 Rolling Meadows Rd
Upper Marlboro, MD 20772-8338

Phone

(301) 627-1675

NPI assigned

Aug 17, 2022

Last updated

Aug 17, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Abdul K. Mansaray

Title

Vice Ceo

Phone

(571) 575-3555

Specialties & licenses 1

Addresses

Other names 1

• LIFE CARE GROUP HOME Former legal business name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1275251126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6403 FRENCHMENS DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223121647",
            "telephone_number": "571-575-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14901 ROLLING MEADOWS RD",
            "city": "UPPER MARLBORO",
            "state": "MD",
            "postal_code": "207728338",
            "telephone_number": "301-627-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE CARE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-17",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "MANSARAY",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "VICE CEO",
        "authorized_official_telephone_number": "571-575-3555"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFE CARE GROUP HOME",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "LIFE CARE GROUP HOME",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Upper Marlboro, MD
• Providers in Upper Marlboro, MD by specialty
• Mental Illness Community Based Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.