MEDICARE: JOHN 316 INTERNATIONAL MINISTRIES 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

General Provider Information

NPI Number	:	1467728915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN 316 INTERNATIONAL MINISTRIES LLC

Provider Business Mailing Address
First Line	:	1133 MCKINLEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5831
Country	:	US
Telephone Number	:	786-752-1733
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 MCKINLEY ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5831
Country	:	US
Telephone Number	:	786-752-1733
Fax Number	:

Authorized Official
Title or Position	:	CEO / OPERATIONS
Name	:	MS. ROSE M. WHITE
Credential	:
Telephone Number	:	786-752-1733

Provider Enumeration Date	:	03/29/2012
Last Update Date	:	03/29/2012

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