Provider Demographics
NPI:1114516176
Name:A1 IN-HOME PRIMARY CARE
Entity Type:Organization
Organization Name:A1 IN-HOME PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, FNP-C
Authorized Official - Phone:443-345-6008
Mailing Address - Street 1:8480 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:SUITE 3210/153
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:443-345-6008
Mailing Address - Fax:443-638-0569
Practice Address - Street 1:6340 SECURITY BLVD STE 100-A9
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5173
Practice Address - Country:US
Practice Address - Phone:443-345-6009
Practice Address - Fax:877-720-3447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-14
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD598024100Medicaid