Healthcare Provider Details

I. General information

NPI: 1740901156
Provider Name (Legal Business Name): MORAVIA HEALTH NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S 4TH ST STE 545
SAINT LOUIS MO
63102-1897
US

IV. Provider business mailing address

1500 WALNUT ST STE 1900
PHILADELPHIA PA
19102-3509
US

V. Phone/Fax

Practice location:
  • Phone: 215-717-8650
  • Fax:
Mailing address:
  • Phone: 215-717-8650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: C. FRANK IGWE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 215-717-8650