Provider Demographics
NPI:1770045908
Name:HOMESAFE FOR SENIORS LLC
Entity Type:Organization
Organization Name:HOMESAFE FOR SENIORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CEAC, CAPS
Authorized Official - Phone:443-473-2030
Mailing Address - Street 1:4901 HARFORD ROAD, #3524
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214
Mailing Address - Country:US
Mailing Address - Phone:443-473-2030
Mailing Address - Fax:
Practice Address - Street 1:5908 EDNA AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1805
Practice Address - Country:US
Practice Address - Phone:443-473-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7777221Medicaid
MD1810162Medicaid