Provider Demographics
NPI:1356532105
Name:UPPER CHESAPEAKE/ST JOSEPH HOMECARE INC
Entity type:Organization
Organization Name:UPPER CHESAPEAKE/ST JOSEPH HOMECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BINDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-931-0990
Mailing Address - Street 1:8003 CORPORATE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4984
Mailing Address - Country:US
Mailing Address - Phone:410-931-0990
Mailing Address - Fax:410-931-2144
Practice Address - Street 1:8003 CORPORATE DR
Practice Address - Street 2:SUITE G
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-4984
Practice Address - Country:US
Practice Address - Phone:410-931-0990
Practice Address - Fax:410-931-2144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1536251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD749200600Medicaid