Healthcare Provider Details

I. General information

NPI: 1891390902
Provider Name (Legal Business Name): SUPPORTIVE CARE RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W BROAD ST FL 11
BETHLEHEM PA
18018-5717
US

IV. Provider business mailing address

1 W BROAD ST FL 11
BETHLEHEM PA
18018-5717
US

V. Phone/Fax

Practice location:
  • Phone: 215-403-7104
  • Fax:
Mailing address:
  • Phone: 267-779-3316
  • 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 Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CHELLI T GROSE-SMITH
Title or Position: CEO
Credential:
Phone: 267-779-3316