Healthcare Provider Details
I. General information
NPI: 1699900449
Provider Name (Legal Business Name): REBEKAH HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/22/2009
Last Update Date: 11/30/2009
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 P.O.BOX 327
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 | 261QH0100X |
| Taxonomy | Health Service Clinic/Center |
| License Number | R2758P |
| License Number State | MD |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 253Z00000X |
| Taxonomy | In Home Supportive Care Agency |
| License Number | R2758P |
| License Number State | MD |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 343800000X |
| Taxonomy | Secured Medical Transport (VAN) |
| License Number | R2758P |
| License Number State | MD |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 132700000X |
| Taxonomy | Dietary Manager |
| License Number | R2758P |
| License Number State | MD |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133N00000X |
| Taxonomy | Nutritionist |
| License Number | R2758P |
| License Number State | MD |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133NN1002X |
| Taxonomy | Nutrition Education Nutritionist |
| License Number | R2758P |
| License Number State | MD |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 146D00000X |
| Taxonomy | Personal Emergency Response Attendant |
| License Number | R2758P |
| License Number State | MD |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 164W00000X |
| Taxonomy | Licensed Practical Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163W00000X |
| Taxonomy | Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WA2000X |
| Taxonomy | Administrator Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP2201X |
| Taxonomy | Ambulatory Care Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC0400X |
| Taxonomy | Case Management Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WC1500X |
| Taxonomy | Community Health Registered Nurse |
| License Number | R2758P |
| License Number State | MD |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 251B00000X |
| Taxonomy | Case Management Agency |
| License Number | R2758P |
| License Number State | MD |
VIII. Authorized Official
Name: MRS.
GLORIA
LYNNE
BROWN-BRISTOL
Title or Position: PRESIDENT ,CEO, EX
Credential:
Phone: 410-922-2617
