=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306234893
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH CARE SERVICES OF MARYLAND. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2015
-----------------------------------------------------
Last Update Date | 01/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1740 E JOPPA RD SUITE 206
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-253-6712
-----------------------------------------------------
Fax | 443-290-4879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1740 E JOPPA RD SUITE 206
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21234-3623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-253-6712
-----------------------------------------------------
Fax | 443-290-4879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MS. SUNSHINE NKEIRUKA AUGUSTA
-----------------------------------------------------
Credential | MBA.
-----------------------------------------------------
Telephone | 443-253-6712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R3592
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------