Provider Demographics
NPI:1992751549
Name:NATIONS HOME INFUSION LLC
Entity type:Organization
Organization Name:NATIONS HOME INFUSION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-248-5590
Mailing Address - Street 1:11521 CRONRIDGE DR
Mailing Address - Street 2:SUITE L-M
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1539
Mailing Address - Country:US
Mailing Address - Phone:888-473-8376
Mailing Address - Fax:855-964-5500
Practice Address - Street 1:11521 CRONRIDGE DR STE L-M
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-1539
Practice Address - Country:US
Practice Address - Phone:888-473-8376
Practice Address - Fax:855-964-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336H0001X, 335G00000X
DCNRX11003263336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038167OtherPK
2038167OtherPK
MD008345300Medicaid
VA010388074Medicaid
MD008345300Medicaid