Provider Demographics
NPI:1871132662
Name:UNITED HOMECARE SUPPORT INC
Entity type:Organization
Organization Name:UNITED HOMECARE SUPPORT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BUSAYO
Authorized Official - Middle Name:DICKSON
Authorized Official - Last Name:AJAYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-635-1657
Mailing Address - Street 1:230 N MAPLE AVE STE B-1 SUITE 314
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-9412
Mailing Address - Country:US
Mailing Address - Phone:443-635-1657
Mailing Address - Fax:
Practice Address - Street 1:45 TAHOE CIR APT B
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3751
Practice Address - Country:US
Practice Address - Phone:443-635-1657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD45674Medicaid