Healthcare Provider Details

I. General information

NPI: 1255645735
Provider Name (Legal Business Name): SENIOR HOME CARE ALLIANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 3RD ST SUITE 504
EASTON PA
18042-1869
US

IV. Provider business mailing address

100 N 3RD ST SUITE 504
EASTON PA
18042-1869
US

V. Phone/Fax

Practice location:
  • Phone: 610-295-5121
  • Fax: 610-628-9668
Mailing address:
  • Phone: 610-295-5121
  • Fax: 610-628-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number20713601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number3948402
License Number StatePA

VIII. Authorized Official

Name: MR. CONSTANTINE KATSIKIS
Title or Position: OWNER
Credential:
Phone: 610-295-5121