Provider Demographics
NPI:1417667015
Name:INDIVIDUAL HOME CARE LLC
Entity Type:Organization
Organization Name:INDIVIDUAL HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNRE/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVGENY
Authorized Official - Middle Name:
Authorized Official - Last Name:GALATYUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-908-4455
Mailing Address - Street 1:200 E PRATT ST STE 466
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-6103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E PRATT ST STE 466
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-6103
Practice Address - Country:US
Practice Address - Phone:844-686-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty