=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508664418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID-MARYLAND SENIOR CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2025
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E PATRICK ST STE 100
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-850-1725
-----------------------------------------------------
Fax | 301-850-1735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 E PATRICK ST STE 100
-----------------------------------------------------
City | FREDERICK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21701-6126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-850-1725
-----------------------------------------------------
Fax | 301-850-1735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLIENT CARE COORDINATOR
-----------------------------------------------------
Name | REBECCA MELBY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-440-4550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------