MEDICARE: BRISBANE HOME CARE AGENCY

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1780568485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRISBANE HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	4212 STOCKTON PL
Second Line	:
City	:	JEFFERSON
State	:	MD
Zip	:	21755-8110
Country	:	US
Telephone Number	:	240-644-2779
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 STOCKTON PL
Second Line	:
City	:	JEFFERSON
State	:	MD
Zip	:	21755-8110
Country	:	US
Telephone Number	:	240-644-2779
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	HECTORIA WELLS
Credential	:
Telephone Number	:	240-644-2779

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	08/05/2025

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Directions to “BRISBANE HOME CARE AGENCY ” Practice Location

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