Healthcare Provider Details

I. General information

NPI: 1235387762
Provider Name (Legal Business Name): HOMECARE REHAB AND NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 03/22/2022
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

197 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4314
US

IV. Provider business mailing address

197 THOMAS JOHNSON DR STE B
FREDERICK MD
21702-4314
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-1997
  • Fax:
Mailing address:
  • Phone: 301-662-1997
  • Fax: 301-668-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateMD

VIII. Authorized Official

Name: BRANDON BAKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-617-0786