Healthcare Provider Details

I. General information

NPI: 1235376005
Provider Name (Legal Business Name): HEPHZIBAH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6115 TWILIGHT CT
BALTIMORE MD
21206-2270
US

IV. Provider business mailing address

6115 TWILIGHT CT
BALTIMORE MD
21206-2270
US

V. Phone/Fax

Practice location:
  • Phone: 240-441-0239
  • Fax: 443-231-6323
Mailing address:
  • Phone: 240-441-0239
  • Fax: 443-231-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR2615
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR2615
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2615
License Number StateMD

VIII. Authorized Official

Name: MRS. ELIZABETH ADEBOWALE OJOYE
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-441-0239