Healthcare Provider Details

I. General information

NPI: 1821808478
Provider Name (Legal Business Name): WAVES OF LIFE HOME CARE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 SMITH AVE
BALTIMORE MD
21209-3701
US

IV. Provider business mailing address

1340 SMITH AVE
BALTIMORE MD
21209-3701
US

V. Phone/Fax

Practice location:
  • Phone: 443-894-8646
  • Fax:
Mailing address:
  • Phone: 443-894-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TEMPLE DEBROCKA PARKER
Title or Position: CEO
Credential:
Phone: 443-894-8646