Provider Demographics
NPI:1467978866
Name:MEDICAL CARE AT HOME, LLC
Entity Type:Organization
Organization Name:MEDICAL CARE AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SLAVA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREYNOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-941-9040
Mailing Address - Street 1:2005 JOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1013
Mailing Address - Country:US
Mailing Address - Phone:1410-941-9040
Mailing Address - Fax:
Practice Address - Street 1:2005 JOLLY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1013
Practice Address - Country:US
Practice Address - Phone:410-941-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-17
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health