Healthcare Provider Details

I. General information

NPI: 1538589718
Provider Name (Legal Business Name): STAFFING VILLAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 GLEN AVON RD
DARBY PA
19023-1414
US

IV. Provider business mailing address

1130 GLEN AVON RD
DARBY PA
19023-1414
US

V. Phone/Fax

Practice location:
  • Phone: 484-540-7697
  • Fax: 484-494-7385
Mailing address:
  • Phone: 484-889-9792
  • Fax: 484-494-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number05300501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number05300501
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number05300501
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number05300501
License Number StatePA

VIII. Authorized Official

Name: MRS. TRINIDA LOVE KOLLIE-JONES
Title or Position: CEO/ADMINISTRATOR/DIRECTOR
Credential: RN
Phone: 484-888-1622