Healthcare Provider Details

I. General information

NPI: 1114505187
Provider Name (Legal Business Name): OUR BIG FAMILY HOME HEALTH CARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BRIDLE LN
NOTTINGHAM MD
21236-4826
US

IV. Provider business mailing address

3 BRIDLE LN
NOTTINGHAM MD
21236-4826
US

V. Phone/Fax

Practice location:
  • Phone: 443-402-5067
  • Fax:
Mailing address:
  • Phone: 443-402-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TANISA SHARNICE THOMPSON
Title or Position: OWNER
Credential:
Phone: 443-402-5067