Healthcare Provider Details

I. General information

NPI: 1417667015
Provider Name (Legal Business Name): INDIVIDUAL HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 HARFORD RD STE 102
BALTIMORE MD
21214-2936
US

IV. Provider business mailing address

4904 HARFORD RD STE 102
BALTIMORE MD
21214-2936
US

V. Phone/Fax

Practice location:
  • Phone: 443-750-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: EVGENY GALATYUK
Title or Position: OWNRE/PRESIDENT
Credential:
Phone: 610-908-4455