Healthcare Provider Details

I. General information

NPI: 1164606406
Provider Name (Legal Business Name): PHR OF BALTIMORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S EDGEWOOD ST SUITE A
BALTIMORE MD
21227-1071
US

IV. Provider business mailing address

7619 LITTLE RIVER TPKE SUITE 600
ANNANDALE VA
22003-2625
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-2825
  • Fax:
Mailing address:
  • Phone: 703-752-8700
  • Fax: 703-752-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number217036
License Number StateMD

VIII. Authorized Official

Name: BRIAN CLEMENS
Title or Position: VP - FINANCE
Credential:
Phone: 703-752-8710