Provider Demographics
NPI:1558594523
Name:MARYLAND HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MARYLAND HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:BEREZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-929-1478
Mailing Address - Street 1:1700 REISTERSTOWN RD
Mailing Address - Street 2:#109
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1416
Mailing Address - Country:US
Mailing Address - Phone:410-486-8303
Mailing Address - Fax:410-486-8305
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:#109
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-486-8303
Practice Address - Fax:410-486-8305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD217161OtherMEDICARE CERTIFICATION NUMBER