Provider Demographics
NPI:1659852580
Name:KELLY CARE, LLC
Entity type:Organization
Organization Name:KELLY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-684-7167
Mailing Address - Street 1:4701 SANGAMORE RD STE S207
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20816-2529
Mailing Address - Country:US
Mailing Address - Phone:202-684-7167
Mailing Address - Fax:240-483-0441
Practice Address - Street 1:4701 SANGAMORE RD STE S207
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20816-2529
Practice Address - Country:US
Practice Address - Phone:202-684-7167
Practice Address - Fax:240-483-0441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR156558OtherLICENSE