Provider Demographics
NPI:1528301082
Name:IZETTA CARE
Entity type:Organization
Organization Name:IZETTA CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMYIA
Authorized Official - Middle Name:SAIHRA
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-584-9164
Mailing Address - Street 1:201 Q ST NE
Mailing Address - Street 2:3536
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2294
Mailing Address - Country:US
Mailing Address - Phone:314-584-9164
Mailing Address - Fax:
Practice Address - Street 1:201 Q ST NE
Practice Address - Street 2:3536
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2294
Practice Address - Country:US
Practice Address - Phone:314-584-9164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care