Provider Demographics
NPI:1164606406
Name:PHR OF BALTIMORE, INC.
Entity Type:Organization
Organization Name:PHR OF BALTIMORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-752-8710
Mailing Address - Street 1:7619 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2625
Mailing Address - Country:US
Mailing Address - Phone:703-752-8700
Mailing Address - Fax:703-752-8719
Practice Address - Street 1:1501 S EDGEWOOD ST
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1071
Practice Address - Country:US
Practice Address - Phone:410-368-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD217036251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217036Medicare Oscar/Certification