1033743471 NPI number — CAREGIVERS OF THE POTOMAC LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033743471 NPI number — CAREGIVERS OF THE POTOMAC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREGIVERS OF THE POTOMAC LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033743471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3717 BOSTON ST # 163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224-5752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 FAIT AVE APT C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21224-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-625-1525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
MELODY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-625-1525

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R213590 . This is a "RN LICENSE - MELODY WARNER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R4288 . This is a "OFFICE OF HEALTHCARE QUALITY LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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