Provider Demographics
NPI:1487212395
Name:ASTREA HOME CARE, INC.
Entity Type:Organization
Organization Name:ASTREA HOME CARE, INC.
Other - Org Name:ASTREA HOME CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ONYEDUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-983-3558
Mailing Address - Street 1:2312 CROSSETT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-1462
Mailing Address - Country:US
Mailing Address - Phone:443-983-3558
Mailing Address - Fax:410-866-6476
Practice Address - Street 1:2312 CROSSETT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-1462
Practice Address - Country:US
Practice Address - Phone:443-983-3558
Practice Address - Fax:410-866-6476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD140904200Medicaid