Healthcare Provider Details

I. General information

NPI: 1821870064
Provider Name (Legal Business Name): PRIMARY HOME CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 N KING ST
WILMINGTON DE
19801-3233
US

IV. Provider business mailing address

1225 N KING ST
WILMINGTON DE
19801-3233
US

V. Phone/Fax

Practice location:
  • Phone: 215-970-5629
  • Fax:
Mailing address:
  • Phone: 215-970-5629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA WARSZEWIK
Title or Position: CREDENTIALING
Credential:
Phone: 701-354-2910