MEDICARE: PERSONAL CARE COORDINATION AGENCY 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	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	:	1346755659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL CARE COORDINATION AGENCY LLC

Provider Business Mailing Address
First Line	:	111 BUCK ROAD
Second Line	:	OFFICE 100 SUITE 1
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1553
Country	:	US
Telephone Number	:	215-327-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 BUCK RD UNIT 100
Second Line	:
City	:	HUNTINGDON VALLEY
State	:	PA
Zip	:	19006-1553
Country	:	US
Telephone Number	:	215-327-3000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANGELICA GIVERTS
Credential	:	D.C.
Telephone Number	:	215-327-3000

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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