MEDICARE: CODERED HEALTHCARE SERVICES 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	:	1891202644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CODERED HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	6136 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3704
Country	:	US
Telephone Number	:	267-516-8048
Fax Number	:

Provider Business Practice Location Address
First Line	:	6136 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3704
Country	:	US
Telephone Number	:	267-516-8048
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	SHAVON NAOMI PARKER
Credential	:
Telephone Number	:	267-516-8048

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	01/02/2018

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