Healthcare Provider Details

I. General information

NPI: 1275098246
Provider Name (Legal Business Name): FIRST SOURCE CAREGIVERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10994 OSWESTRY ST STE 2020
WALDORF MD
20603-4886
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

V. Phone/Fax

Practice location:
  • Phone: 240-346-2980
  • Fax:
Mailing address:
  • Phone: 240-346-2980
  • Fax:

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
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA STEWART- COLE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 240-464-1982