Provider Demographics
NPI:1245822022
Name:MARYLAND INTERGENERATIONAL HEALTH CARE
Entity type:Organization
Organization Name:MARYLAND INTERGENERATIONAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-375-1491
Mailing Address - Street 1:814 PRIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4604
Mailing Address - Country:US
Mailing Address - Phone:410-375-1491
Mailing Address - Fax:
Practice Address - Street 1:814 PRIMSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4604
Practice Address - Country:US
Practice Address - Phone:410-375-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health