Provider Demographics
NPI:1235376005
Name:HEPHZIBAH CARE SERVICES LLC
Entity Type:Organization
Organization Name:HEPHZIBAH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ADEBOWALE
Authorized Official - Last Name:OJOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-441-0239
Mailing Address - Street 1:6115 TWILIGHT CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-2270
Mailing Address - Country:US
Mailing Address - Phone:240-441-0239
Mailing Address - Fax:443-231-6323
Practice Address - Street 1:6115 TWILIGHT CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-2270
Practice Address - Country:US
Practice Address - Phone:240-441-0239
Practice Address - Fax:443-231-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2615251E00000X, 251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6432034-00Medicaid