Provider Demographics
NPI:1861116758
Name:CARUTH STAFFING AGENCY P.C.
Entity type:Organization
Organization Name:CARUTH STAFFING AGENCY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:JUNETTE
Authorized Official - Last Name:CARUTH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:240-245-0039
Mailing Address - Street 1:2114 GARDEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-1883
Mailing Address - Country:US
Mailing Address - Phone:240-245-0039
Mailing Address - Fax:301-542-0125
Practice Address - Street 1:2114 GARDEN GROVE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-1883
Practice Address - Country:US
Practice Address - Phone:240-245-0039
Practice Address - Fax:301-542-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD241685Medicaid