Provider Demographics
NPI:1215769799
Name:DAVICK ENTERPRISE,LLC
Entity type:Organization
Organization Name:DAVICK ENTERPRISE,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:DEDEOCOYOO
Authorized Official - Last Name:ATTRAM BONDZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-898-7867
Mailing Address - Street 1:2628 N EVERLY DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-1510
Mailing Address - Country:US
Mailing Address - Phone:240-898-7867
Mailing Address - Fax:
Practice Address - Street 1:2628 N EVERLY DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-1510
Practice Address - Country:US
Practice Address - Phone:240-898-7867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVICK CARE SOLUTIONS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management