Healthcare Provider Details

I. General information

NPI: 1013612639
Provider Name (Legal Business Name): PLEASANT HAVEN HOME CARE PROVIDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 JOSHUA TREE CT
OWINGS MILLS MD
21117-1730
US

IV. Provider business mailing address

833 JOSHUA TREE CT
OWINGS MILLS MD
21117-1730
US

V. Phone/Fax

Practice location:
  • Phone: 443-414-9884
  • Fax:
Mailing address:
  • Phone: 443-414-9884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LUIS HARDMON
Title or Position: OWNWE
Credential:
Phone: 443-414-9884