Provider Demographics
NPI:1639590664
Name:PHENOMENAL CARE
Entity Type:Organization
Organization Name:PHENOMENAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYSHEENA
Authorized Official - Middle Name:EVETTE
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-801-2967
Mailing Address - Street 1:4990 MERCANTILE RD
Mailing Address - Street 2:UNIT 43662
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-8500
Mailing Address - Country:US
Mailing Address - Phone:443-801-2967
Mailing Address - Fax:
Practice Address - Street 1:4006 BIDDISON LN
Practice Address - Street 2:#3A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4146
Practice Address - Country:US
Practice Address - Phone:443-801-2967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care