Provider Demographics
NPI:1154183374
Name:AMAZING HOMECARE HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:AMAZING HOMECARE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MESIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-486-7509
Mailing Address - Street 1:12401 BRICKYARD BLVD APT 3108
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1648
Mailing Address - Country:US
Mailing Address - Phone:240-821-2411
Mailing Address - Fax:
Practice Address - Street 1:12401 BRICKYARD BLVD APT 3108
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1648
Practice Address - Country:US
Practice Address - Phone:202-486-7509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMAZING HOMECARE HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental ModificationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty