Provider Demographics
NPI:1316419997
Name:PROVIDER HOMECARE, LLC
Entity type:Organization
Organization Name:PROVIDER HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABATUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-938-5986
Mailing Address - Street 1:10482 BALTIMORE AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2321
Mailing Address - Country:US
Mailing Address - Phone:301-938-5986
Mailing Address - Fax:
Practice Address - Street 1:11220 EVANS TRL APT 203
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3913
Practice Address - Country:US
Practice Address - Phone:301-938-5986
Practice Address - Fax:240-542-4398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty