Provider Demographics
NPI:1720477698
Name:ONSITE GERIATRIC CARE LLC
Entity type:Organization
Organization Name:ONSITE GERIATRIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:202-361-6670
Mailing Address - Street 1:107 TRAILING IVY LN
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4735
Mailing Address - Country:US
Mailing Address - Phone:202-361-6670
Mailing Address - Fax:
Practice Address - Street 1:107 TRAILING IVY LN
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4735
Practice Address - Country:US
Practice Address - Phone:202-361-6670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC302R00000X, 310400000X
MD302R00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No302R00000XManaged Care OrganizationsHealth Maintenance Organization