NPIMap

Organization Active NPI

Private Home Care LLC

  • In Home Supportive Care Agency
  • Pikesville, MD
National Provider Identifier
1114516648
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
PRIVATE HOME CARE LLC
Practice address
1700 Reisterstown Rd Ste 208
Pikesville, MD 21208-2920
Phone
(410) 486-6565
Fax
(410) 486-6606
NPI assigned
Jan 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Olga Gimburg
Title
Executive Director
Phone
(410) 486-6565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
In Home Supportive Care Agency 253Z00000X Primary

Addresses

Primary practice location

1700 Reisterstown Rd Ste 208
Pikesville, MD 21208-2920

Mailing address

1700 Reisterstown Rd Ste 208
Pikesville, MD 21208-2920
Phone (410) 486-6565

Other identifiers 1

IdentifierTypeStateIssuer
955301100MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://ssoltss.health.maryland.gov Health Information Exchange (HIE) State of Maryland - DHMH

National Provider Directory

National Provider Directory

Locations

1700 Reisterstown Rd
Ste 208
Pikesville, MD 21208
Phone (410) 486-6565

NPI Registry JSON

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

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1114516648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 REISTERSTOWN RD STE 208",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212082920",
            "telephone_number": "410-486-6565",
            "fax_number": "410-486-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 REISTERSTOWN RD STE 208",
            "city": "PIKESVILLE",
            "state": "MD",
            "postal_code": "212082920",
            "telephone_number": "410-486-6565",
            "fax_number": "410-486-6606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "GIMBURG",
        "authorized_official_first_name": "OLGA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "410-486-6565"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "955301100",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://ssoltss.health.maryland.gov",
            "affiliation": "Y",
            "affiliationName": "State of Maryland - DHMH",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1700 Reisterstown Rd Ste 208",
            "city": "Pikesville",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212082920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pikesville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.