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General NPI Number Information
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NPI Number | 1942343041
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Entity Type | Organization
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Legal Business Name | MEDSOURCE COMMUNITY SERVICES INC. DBA SENIOR HOME CARE OF FREDERICK
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6910 BOWERS RD STE C
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City | FREDERICK
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State | MD
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Zip | 21702-3614
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Country | US
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Telephone | 301-473-5633
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Fax | 301-473-8585
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Provider Business Mailing Address
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Address Line | 1315 ORCHARD WAY
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City | FREDERICK
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State | MD
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Zip | 21703-6002
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Country | US
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Telephone | 301-846-0160
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Fax | 301-846-0267
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ROBERT CLAXTON
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Credential |
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Telephone | 301-991-6963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | R2122
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License Number State | MD
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