Provider Demographics
NPI:1043705502
Name:C AND C LOVING HEART HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:C AND C LOVING HEART HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON-WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-867-7471
Mailing Address - Street 1:5122 CREST HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9793
Mailing Address - Country:US
Mailing Address - Phone:410-256-5710
Mailing Address - Fax:410-256-6052
Practice Address - Street 1:5122 CREST HAVEN WAY
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128
Practice Address - Country:US
Practice Address - Phone:410-256-5710
Practice Address - Fax:410-256-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X, 251E00000X, 253Z00000X
MDR158240251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care