MEDICARE: ALIVE HEALTHCARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174168207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALIVE HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	6133 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	301-221-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6133 SILVER ARROWS WAY
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-7411
Country	:	US
Telephone Number	:	301-221-5373
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR OF NURSING
Name	:	DIANA EDEM MACGOLD
Credential	:
Telephone Number	:	301-221-5373

Provider Enumeration Date	:	11/13/2019
Last Update Date	:	11/13/2019

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