Healthcare Provider Details

I. General information

NPI: 1164236766
Provider Name (Legal Business Name): THE SOURCE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

8310 LIBERTY RD
WINDSOR MILL MD
21244-3124
US

IV. Provider business mailing address

8310 LIBERTY RD
WINDSOR MILL MD
21244-3124
US

V. Phone/Fax

Practice location:
  • Phone: 410-816-5120
  • Fax:
Mailing address:
  • Phone: 410-816-5120
  • 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 Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN WILLIAMS
Title or Position: CEO
Credential: CEO
Phone: 410-816-5120