Healthcare Provider Details

I. General information

NPI: 1245891589
Provider Name (Legal Business Name): AMANAH HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

IV. Provider business mailing address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

V. Phone/Fax

Practice location:
  • Phone: 419-290-5053
  • Fax: 443-269-0754
Mailing address:
  • Phone: 419-290-5053
  • Fax: 443-269-0754

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEFANIE ELIZABETH TAYLOR
Title or Position: OWNER
Credential:
Phone: 419-290-5053