Provider Demographics
NPI:1104032507
Name:HOME HEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:HOME HEALTH CARE SERVICES LLC
Other - Org Name:BLAKEHURST CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-272-5866
Mailing Address - Street 1:1055 W JOPPA RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3741
Mailing Address - Country:US
Mailing Address - Phone:561-272-5866
Mailing Address - Fax:
Practice Address - Street 1:1055 W JOPPA RD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3741
Practice Address - Country:US
Practice Address - Phone:561-272-5866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD544POtherPTAN NUMBER FROM TRAILBLAZER ENTERPRISES
MD544POtherPTAN NUMBER FROM TRAILBLAZER ENTERPRISES