Provider Demographics
NPI:1942329990
Name:TWENTY FOUR HOUR DEPENDABLE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:TWENTY FOUR HOUR DEPENDABLE MEDICAL SUPPLIES, LLC
Other - Org Name:TWENTY FOUR HOUR DEPENDABLE MEDICAL SUPPLIES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-344-1414
Mailing Address - Street 1:1371 BRASS MILL RD STE N
Mailing Address - Street 2:
Mailing Address - City:BELCAMP
Mailing Address - State:MD
Mailing Address - Zip Code:21017-1239
Mailing Address - Country:US
Mailing Address - Phone:410-344-1414
Mailing Address - Fax:410-344-1344
Practice Address - Street 1:1371 BRASS MILL RD STE N
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1239
Practice Address - Country:US
Practice Address - Phone:141-034-4141
Practice Address - Fax:410-344-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2571332B00000X
MDPW03793336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140066OtherPK
MD012839200Medicaid
2140066OtherPK