Healthcare Provider Details

I. General information

NPI: 1346866969
Provider Name (Legal Business Name): A WATCHFUL EYE HOMECARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 YORK RD
TIMONIUM MD
21093-2217
US

IV. Provider business mailing address

14112 WOODENS LN
REISTERSTOWN MD
21136-4540
US

V. Phone/Fax

Practice location:
  • Phone: 443-898-6159
  • Fax:
Mailing address:
  • Phone: 410-905-1226
  • Fax: 443-898-6159

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY SKINNER
Title or Position: OWNER
Credential:
Phone: 443-431-3688