Provider Demographics
NPI:1811194061
Name:MARYLAND HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:MARYLAND HEALTHCARE SERVICES INC
Other - Org Name:REVIVAL HOMECARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELZEND
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MBA&M
Authorized Official - Phone:888-225-6994
Mailing Address - Street 1:1101 MERCANTILE LN STE 292
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5363
Mailing Address - Country:US
Mailing Address - Phone:888-225-6994
Mailing Address - Fax:888-592-3644
Practice Address - Street 1:1101 MERCANTILE LN
Practice Address - Street 2:SUITE 292
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5360
Practice Address - Country:US
Practice Address - Phone:888-225-6994
Practice Address - Fax:888-592-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7047251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD414786300Medicaid
DCHCA-0109OtherHOME CARE
MDHCO-512309OtherJOINT COMMISSION