Healthcare Provider Details

I. General information

NPI: 1629587498
Provider Name (Legal Business Name): KORMI HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 MELROSE AVE
EAST LANSDOWNE PA
19050-2527
US

IV. Provider business mailing address

23 MELROSE AVE
EAST LANSDOWNE PA
19050-2527
US

V. Phone/Fax

Practice location:
  • Phone: 484-273-9366
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number34113601
License Number StatePA

VIII. Authorized Official

Name: KORTO GOLOWO
Title or Position: RN
Credential:
Phone: 313-467-6604