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NPI Code Detail

MEDICARE: PROVIDER HOMECARE, LLC

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
1374U00000XHome 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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