Providence in-Home Care Services

Primary specialty

Nurse's AideTaxonomy code 376K00000X

Legal business name

PROVIDENCE IN-HOME CARE SERVICES

Practice address

12652 Piedmont Trail Rd
Clarksburg, MD 20871-4305

Phone

(240) 614-6946

NPI assigned

Sep 22, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Funmilayo Johnson

Title

Owner

Phone

(240) 614-6946

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1758499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758499200000",
    "number": "1104798917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12652 PIEDMONT TRAIL RD",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714305",
            "telephone_number": "240-614-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12652 PIEDMONT TRAIL RD",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714305",
            "telephone_number": "240-614-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE IN-HOME CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-22",
        "last_updated": "2025-09-22",
        "certification_date": "2025-09-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "FUNMILAYO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "240-614-6946"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse's Aide",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Clarksburg, MD
• Nurse's Aide in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.