MEDICARE: MAPLE LEAF HOME CARE SERVICES 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	372600000X	Adult Companion
2	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295393122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAPLE LEAF HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6339 ALGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5802
Country	:	US
Telephone Number	:	267-815-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 ALGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5802
Country	:	US
Telephone Number	:	267-815-8544
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. EMMANUEL MARRERO
Credential	:
Telephone Number	:	267-388-7434

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/20/2019

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