MEDICARE: PROVIDER HOMECARE, LLC

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1316419997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDER HOMECARE, LLC

Provider Business Mailing Address
First Line	:	10482 BALTIMORE AVE STE 260
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-2321
Country	:	US
Telephone Number	:	301-938-5986
Fax Number	:

Provider Business Practice Location Address
First Line	:	11220 EVANS TRL APT 203
Second Line	:
City	:	BELTSVILLE
State	:	MD
Zip	:	20705-3913
Country	:	US
Telephone Number	:	301-938-5986
Fax Number	:	240-542-4398

Authorized Official
Title or Position	:	CEO
Name	:	ELISABETH BABATUNDE
Credential	:
Telephone Number	:	301-938-5986

Provider Enumeration Date	:	12/20/2018
Last Update Date	:	12/20/2018

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Directions to “PROVIDER HOMECARE, LLC ” Practice Location

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