Healthcare Provider Details

I. General information

NPI: 1770182115
Provider Name (Legal Business Name): EMMANUEL HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8174 LARK BROWN RD STE 201
ELKRIDGE MD
21075-6426
US

IV. Provider business mailing address

8174 LARK BROWN RD STE 201
ELKRIDGE MD
21075-6426
US

V. Phone/Fax

Practice location:
  • Phone: 443-288-6677
  • Fax:
Mailing address:
  • Phone: 443-288-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA SOL
Title or Position: CEO/ADMINISTRATOR
Credential: RN
Phone: 443-288-6677