MEDICARE: MS. TIARRA LASHAE GRIFFIN

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	74033601	PA

General Provider Information

NPI Number	:	1518737576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIARRA LASHAE GRIFFIN

Provider Business Mailing Address
First Line	:	5442 DISCHER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-1105
Country	:	US
Telephone Number	:	267-872-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	5442 DISCHER ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-1105
Country	:	US
Telephone Number	:	267-872-8660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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