MEDICARE: PENN'S ROCK 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	:	1518576784
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENN'S ROCK HOME CARE, LLC

Provider Business Mailing Address
First Line	:	801 WASHINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4716
Country	:	US
Telephone Number	:	267-519-9353
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 WASHINGTON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-4716
Country	:	US
Telephone Number	:	267-519-9353
Fax Number	:

Authorized Official
Title or Position	:	MEMBER, CEO, PRESIDENT
Name	:	NACOMO FINNELL
Credential	:
Telephone Number	:	267-519-9353

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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