Provider Demographics
NPI:1942343041
Name:MEDSOURCE COMMUNITY SERVICES INC. DBA SENIOR HOME CARE OF FREDERICK
Entity Type:Organization
Organization Name:MEDSOURCE COMMUNITY SERVICES INC. DBA SENIOR HOME CARE OF FREDERICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-991-6963
Mailing Address - Street 1:1315 ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6002
Mailing Address - Country:US
Mailing Address - Phone:301-846-0160
Mailing Address - Fax:301-846-0267
Practice Address - Street 1:6910 BOWERS RD STE C
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-3614
Practice Address - Country:US
Practice Address - Phone:301-473-5633
Practice Address - Fax:301-473-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2122251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care