MEDICARE: PEARL OF DAWN HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1063366730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL OF DAWN HOME CARE LLC

Provider Business Mailing Address
First Line	:	50 E WILLOW GROVE AVE STE 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3464
Country	:	US
Telephone Number	:	267-577-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 E WILLOW GROVE AVE STE 1
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3464
Country	:	US
Telephone Number	:	267-577-9806
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHANTE OCTAVIA JACKSON
Credential	:	LPN
Telephone Number	:	267-577-9806

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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