Provider Demographics
NPI:1265290712
Name:CROWN CARE CORPORATION
Entity type:Organization
Organization Name:CROWN CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADEGBENGA
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:KILADEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-416-1579
Mailing Address - Street 1:5403 RICHARDSONS ENDEAVOR DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3390
Mailing Address - Country:US
Mailing Address - Phone:240-416-1579
Mailing Address - Fax:
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8336
Practice Address - Country:US
Practice Address - Phone:240-416-1579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities