Provider Demographics
NPI:1699900449
Name:REBEKAH HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:REBEKAH HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ,CEO, EX
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:LYNNE
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:P.O.BOX 327
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:2009-05-22
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2758P132700000X, 133N00000X, 133NN1002X, 146D00000X, 163W00000X, 163WA0400X, 163WA2000X, 163WC0400X, 163WC1500X, 163WP2201X, 164W00000X, 251B00000X, 253Z00000X, 261QH0100X, 343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherAARP
MD=========OtherBLUE CROSS BLUE SHEILD
MD=========OtherCAREFIRST BLUECHOICE
MD=========Medicaid
MD=========OtherGENWORTH FINANCIAL
MD=========OtherKAIRSERI PERMENTE
MD=========OtherALL KINDS OF LONG TERM CARE INSURANCES
MD=========Medicare PIN
MD=========OtherBLUE CROSS BLUE SHEILD