Provider Demographics
NPI:1306234893
Name:HEALTH CARE SERVICES OF MARYLAND. LLC
Entity type:Organization
Organization Name:HEALTH CARE SERVICES OF MARYLAND. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUNSHINE
Authorized Official - Middle Name:NKEIRUKA
Authorized Official - Last Name:AUGUSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:443-253-6712
Mailing Address - Street 1:1740 E JOPPA RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3623
Mailing Address - Country:US
Mailing Address - Phone:443-253-6712
Mailing Address - Fax:443-290-4879
Practice Address - Street 1:1740 E JOPPA RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3623
Practice Address - Country:US
Practice Address - Phone:443-253-6712
Practice Address - Fax:443-290-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3592251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5861Medicaid
MD1740Medicaid