Organization
PROVIDENCE IN-HOME CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FUNMILAYO JOHNSON (OWNER)
(240) 614-6946
Entity
Organization
Contact information
Practice address
12652 PIEDMONT TRAIL RD, CLARKSBURG, MD 20871-4305
(240) 614-6946
Mailing address
12652 PIEDMONT TRAIL RD, CLARKSBURG, MD 20871-4305
(240) 614-6946
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
—
Other
Enumeration date
09/22/2025
Last updated
09/22/2025
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