Healthcare Provider Details

I. General information

NPI: 1477158889
Provider Name (Legal Business Name): GMG HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17813 FARRAGUT WAY
HAGERSTOWN MD
21740-6395
US

IV. Provider business mailing address

17813 FARRAGUT WAY
HAGERSTOWN MD
21740-6395
US

V. Phone/Fax

Practice location:
  • Phone: 301-524-7301
  • Fax:
Mailing address:
  • Phone: 240-513-6856
  • Fax: 240-465-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA TENNOR
Title or Position: ADMINISTRATOR
Credential: RN, BSN, MHA
Phone: 301-524-7301