Provider Demographics
NPI:1063902674
Name:PRECIOUS HEARTS COMPANION CARE, INC
Entity type:Organization
Organization Name:PRECIOUS HEARTS COMPANION CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AFOLABI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:410-963-1519
Mailing Address - Street 1:3517 LANGREHR ROAD, SUITE E201
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:410-963-1519
Mailing Address - Fax:410-298-4205
Practice Address - Street 1:3517 LANGREHR ROAD, SUITE E201
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-0121
Practice Address - Country:US
Practice Address - Phone:410-963-1519
Practice Address - Fax:410-298-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904204100251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD904204100Medicaid