Provider Demographics
NPI:1275098246
Name:FIRST SOURCE CAREGIVERS LLC
Entity type:Organization
Organization Name:FIRST SOURCE CAREGIVERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART- COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-464-1982
Mailing Address - Street 1:3261 OLD WASHINGTON RD STE 2020
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3231
Mailing Address - Country:US
Mailing Address - Phone:240-346-2980
Mailing Address - Fax:
Practice Address - Street 1:10994 OSWESTRY ST STE 2020
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4886
Practice Address - Country:US
Practice Address - Phone:240-346-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD251E00000XOtherHOME HEALTH