Provider Demographics
NPI:1821873209
Name:CITADEL HOME HEALTHCARE LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:CITADEL HOME HEALTHCARE LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:MALCOLM
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:443-929-0406
Mailing Address - Street 1:2111 SUNBRIAR LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5987
Mailing Address - Country:US
Mailing Address - Phone:443-929-0406
Mailing Address - Fax:443-308-0793
Practice Address - Street 1:2111 SUNBRIAR LN UNIT B
Practice Address - Street 2:
Practice Address - City:GWYNN OAK
Practice Address - State:MD
Practice Address - Zip Code:21207-5987
Practice Address - Country:US
Practice Address - Phone:443-929-0406
Practice Address - Fax:443-308-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty