Provider Demographics
NPI:1871283150
Name:RICHARDSON, CASSEY A (HOME CARE PROVIDER)
Entity type:Individual
Prefix:
First Name:CASSEY
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22068
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21203-4068
Mailing Address - Country:US
Mailing Address - Phone:443-525-2478
Mailing Address - Fax:
Practice Address - Street 1:614 WOODBOURNE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4204
Practice Address - Country:US
Practice Address - Phone:144-352-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health