Healthcare Provider Details

I. General information

NPI: 1215364229
Provider Name (Legal Business Name): PREFERRED HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4134 E JOPPA RD
BALTIMORE MD
21236-2284
US

IV. Provider business mailing address

4134 E JOPPA RD
BALTIMORE MD
21236-2284
US

V. Phone/Fax

Practice location:
  • Phone: 410-248-9800
  • Fax:
Mailing address:
  • Phone: 410-248-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14331
License Number StateMD

VIII. Authorized Official

Name: MS. LINDA GRAY
Title or Position: CEO
Credential: RN
Phone: 410-248-9800