Healthcare Provider Details

I. General information

NPI: 1114662657
Provider Name (Legal Business Name): OUTLAW TENDER TOUCH HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 04/29/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CAMBRIDGE ROAD
CLIFTON HEIGHTS PA
19018
US

IV. Provider business mailing address

PO BOX 872
HAVERTOWN PA
19083-0872
US

V. Phone/Fax

Practice location:
  • Phone: 610-609-7076
  • Fax: 610-424-3253
Mailing address:
  • Phone: 267-624-6304
  • Fax: 610-424-3253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE TAMEKA SOLOMON-OUTLAW
Title or Position: OWNER
Credential:
Phone: 267-624-6304