Provider Demographics
NPI:1922786284
Name:WATERFALLS AT HOME, LLC
Entity Type:Organization
Organization Name:WATERFALLS AT HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:MARGARITA
Authorized Official - Last Name:GAVILANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-630-1089
Mailing Address - Street 1:305 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4255
Mailing Address - Country:US
Mailing Address - Phone:443-833-6416
Mailing Address - Fax:410-744-1528
Practice Address - Street 1:305 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4255
Practice Address - Country:US
Practice Address - Phone:443-833-6416
Practice Address - Fax:410-744-1528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health