Healthcare Provider Details

I. General information

NPI: 1750593893
Provider Name (Legal Business Name): GENERAL HEALTHCARE RESOURCES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 TOWANDA AVENUE
BALTIMORE MD
21215-6214
US

IV. Provider business mailing address

4407 TOWANDA AVENUE
BALTIMORE MD
21215-6214
US

V. Phone/Fax

Practice location:
  • Phone: 410-367-5975
  • Fax: 410-367-5975
Mailing address:
  • Phone: 410-367-5975
  • Fax: 410-367-5975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberLP14596
License Number StateMD

VIII. Authorized Official

Name: MRS. LOUVINIA MATHILDE BLACKSTON
Title or Position: LICENSED PRACTICAL NURSE
Credential:
Phone: 410-367-5975