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General NPI Number Information
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NPI Number | 1366442089
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Entity Type | Organization
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Legal Business Name | ST. AGNES HOME CARE
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 1501 S EDGEWOOD ST SUITE A
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City | BALTIMORE
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State | MD
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Zip | 21227-1071
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Country | US
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Telephone | 410-368-2825
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Fax | 410-368-8449
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Provider Business Mailing Address
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Address Line | 1501 S EDGEWOOD ST SUITE A
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City | BALTIMORE
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State | MD
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Zip | 21227-1071
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Country | US
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Telephone | 410-368-2825
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Fax | 410-368-8449
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. BRIAN CLEMENS
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Credential |
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Telephone | 703-752-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HH7036R
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License Number State | MD
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