MEDICARE: ETANA 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1760263420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETANA CARE INC

Provider Business Mailing Address
First Line	:	6022 LINDBERGH BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19142-3428
Country	:	US
Telephone Number	:	215-280-3985
Fax Number	:	445-999-5388

Provider Business Practice Location Address
First Line	:	438 N 64TH ST FRNT
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-4038
Country	:	US
Telephone Number	:	215-280-3985
Fax Number	:	445-999-5388

Authorized Official
Title or Position	:	OWNER
Name	:	MS. AYANNA HICKSON
Credential	:
Telephone Number	:	215-280-3985

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “ETANA CARE INC ” Practice Location

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