MEDICARE: MINERVA HOME HEALTH CARE, INC

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	R3104	MD

General Provider Information

NPI Number	:	1194004770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINERVA HOME HEALTH CARE, INC

Provider Business Mailing Address
First Line	:	2301 DORSEY RD STE 111
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3276
Country	:	US
Telephone Number	:	240-603-5025
Fax Number	:

Provider Business Practice Location Address
First Line	:	9120 CHESAPEAKE AVE STE 201
Second Line	:
City	:	NORTH BEACH
State	:	MD
Zip	:	20714-5043
Country	:	US
Telephone Number	:	240-603-5025
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. FOLASHADE E GREEN
Credential	:	RN
Telephone Number	:	240-560-5080

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	03/11/2021

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