MEDICARE: AT PEACE HEALTH CARE 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	251E00000X	Home Health Agency	04500501	PA

General Provider Information

NPI Number	:	1417230764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT PEACE HEALTH CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	3222 W CHELTENHAM AVE
Second Line	:	SUITE A1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	215-525-6441
Fax Number	:

Provider Business Practice Location Address
First Line	:	3222 W CHELTENHAM AVE
Second Line	:	SUITE A1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1003
Country	:	US
Telephone Number	:	215-525-6441
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. EBONY BARRIER
Credential	:	RN
Telephone Number	:	267-591-8062

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	03/09/2012

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