Provider Demographics
NPI:1083949655
Name:REBEKAH HOME HEALTHCARE,LLC
Entity type:Organization
Organization Name:REBEKAH HOME HEALTHCARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER CEO/ EXCUTIVE OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:GLOIRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROWN- BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-922-2617
Mailing Address - Street 1:3829 KILBURN RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4655
Mailing Address - Country:US
Mailing Address - Phone:410-922-2617
Mailing Address - Fax:410-922-4620
Practice Address - Street 1:3829 KILBURN RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4655
Practice Address - Country:US
Practice Address - Phone:410-922-2617
Practice Address - Fax:410-922-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2800R163WA2000X, 251C00000X, 251G00000X, 251J00000X, 305R00000X, 305S00000X, 320600000X, 320900000X, 324500000X, 332B00000X, 332BD1200X, 332BP3500X, 332U00000X, 333600000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332U00000XSuppliersHome Delivered Meals
No333600000XSuppliersPharmacy