Provider Demographics
NPI:1306186911
Name:HOME PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:HOME PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FUZAYL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:410-205-6525
Mailing Address - Street 1:6940 CLEARWIND COURT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-205-6525
Mailing Address - Fax:410-602-5303
Practice Address - Street 1:6940 CLEARWIND COURT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-205-6525
Practice Address - Fax:410-602-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center