Provider Demographics
NPI:1063247328
Name:SOLACESTAR CARE LLC
Entity type:Organization
Organization Name:SOLACESTAR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EJINAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-643-7073
Mailing Address - Street 1:5620 SAINT BARNABAS RD
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3628
Mailing Address - Country:US
Mailing Address - Phone:240-643-7073
Mailing Address - Fax:
Practice Address - Street 1:5620 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3628
Practice Address - Country:US
Practice Address - Phone:240-643-7073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)