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General NPI Number Information
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NPI Number | 1316419997
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Entity Type | Organization
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Legal Business Name | PROVIDER HOMECARE, LLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 11220 EVANS TRL APT 203
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City | BELTSVILLE
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State | MD
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Zip | 20705-3913
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Country | US
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Telephone | 301-938-5986
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Fax | 240-542-4398
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Provider Business Mailing Address
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Address Line | 10482 BALTIMORE AVE STE 260
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City | BELTSVILLE
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State | MD
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Zip | 20705-2321
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Country | US
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Telephone | 301-938-5986
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ELISABETH BABATUNDE
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Credential |
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Telephone | 301-938-5986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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