MEDICARE: PHILADELPHIA COMMUNITY CARE, INC.

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	766505	PA

General Provider Information

NPI Number	:	1629090741
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILADELPHIA COMMUNITY CARE, INC.

Provider Business Mailing Address
First Line	:	2709 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 E LEHIGH AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19125-4008
Country	:	US
Telephone Number	:	215-744-9200
Fax Number	:	215-744-9522

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STAN EYRE
Credential	:
Telephone Number	:	215-744-9200

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/28/2008

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