Healthcare Provider Details

I. General information

NPI: 1790139442
Provider Name (Legal Business Name): REHOBOTH HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10085 RED RUN BLVD STE 104 SUITE 104
OWINGS MILLS MD
21117-4811
US

IV. Provider business mailing address

10085 RED RUN BLVD SUITE 104
OWINGS MILLS MD
21117-4836
US

V. Phone/Fax

Practice location:
  • Phone: 443-352-3818
  • Fax: 443-379-0051
Mailing address:
  • Phone: 443-352-3818
  • Fax: 443-379-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP07055
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEAN TANON
Title or Position: DIRECTOR
Credential:
Phone: 443-352-3818