MEDICARE: REHOBOTH 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	3336L0003X	Long Term Care Pharmacy
2	3336C0004X	Compounding Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	3336C0003X	Community/Retail Pharmacy
5	333600000X	Pharmacy	P07055	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2159837	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790139442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHOBOTH HEALTHCARE SERVICES

Provider Business Mailing Address
First Line	:	10085 RED RUN BLVD
Second Line	:	SUITE 104
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4836
Country	:	US
Telephone Number	:	443-352-3818
Fax Number	:	443-379-0051

Provider Business Practice Location Address
First Line	:	10085 RED RUN BLVD STE 104
Second Line	:	SUITE 104
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4811
Country	:	US
Telephone Number	:	443-352-3818
Fax Number	:	443-379-0051

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JEAN TANON
Credential	:
Telephone Number	:	443-352-3818

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	09/02/2016

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Directions to “REHOBOTH HEALTHCARE SERVICES ” Practice Location

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