Healthcare Provider Details
I. General information
NPI: 1073849154
Provider Name (Legal Business Name): REBEKAH HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3829 KILBURN RD
RANDALLSTOWN MD
21133-4655
US
IV. Provider business mailing address
3829 KILBURN RD
RANDALLSTOWN MD
21133-4655
US
V. Phone/Fax
- Phone: 410-922-2617
- Fax: 410-922-4620
- Phone: 410-922-2617
- Fax: 410-922-4620
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WR0400X |
| Taxonomy | Rehabilitation Registered Nurse |
| License Number | R2800R |
| License Number State | MD |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WS0200X |
| Taxonomy | School Registered Nurse |
| License Number | R2800R |
| License Number State | MD |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WU0100X |
| Taxonomy | Urology Registered Nurse |
| License Number | R2800R |
| License Number State | MD |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | R2800R |
| License Number State | MD |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0101X |
| Taxonomy | Ambulatory Women's Health Care Registered Nurse |
| License Number | R2800R |
| License Number State | MD |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332BD1200X |
| Taxonomy | Dialysis Equipment & Supplies (DME) |
| License Number | R2800R |
| License Number State | MD |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 347B00000X |
| Taxonomy | Bus |
| License Number | R2800R |
| License Number State | MD |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 347C00000X |
| Taxonomy | Private Vehicle |
| License Number | R2800R |
| License Number State | MD |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 372600000X |
| Taxonomy | Adult Companion |
| License Number | R2800R |
| License Number State | MD |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374700000X |
| Taxonomy | Technician |
| License Number | R2800R |
| License Number State | MD |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 3747A0650X |
| Taxonomy | Attendant Care Provider |
| License Number | R2800R |
| License Number State | MD |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 374U00000X |
| Taxonomy | Home Health Aide |
| License Number | R2800R |
| License Number State | MD |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376J00000X |
| Taxonomy | Homemaker |
| License Number | R2800R |
| License Number State | MD |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 376K00000X |
| Taxonomy | Nurse's Aide |
| License Number | R2800R |
| License Number State | MD |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 163WR0006X |
| Taxonomy | Registered Nurse First Assistant |
| License Number | R2800R |
| License Number State | MD |
VIII. Authorized Official
Name: MS.
GLORIA
LYNN
BROWN- BRISTOL
Title or Position: FOUNDER CEO/ EXCUTIVE OFFER
Credential:
Phone: 410-922-2617
