Provider Demographics
NPI:1053455162
Name:PREFERRED HOME CARE LLC
Entity Type:Organization
Organization Name:PREFERRED HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-248-9800
Mailing Address - Street 1:4134 E JOPPA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2284
Mailing Address - Country:US
Mailing Address - Phone:410-248-9800
Mailing Address - Fax:410-248-9801
Practice Address - Street 1:4134 E JOPPA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-2284
Practice Address - Country:US
Practice Address - Phone:410-248-9800
Practice Address - Fax:410-248-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411237700Medicaid