Healthcare Provider Details

I. General information

NPI: 1457394397
Provider Name (Legal Business Name): ASERACARE HOME HEALTH - PHILADELPHIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 STOCKTON DR SUITE 100
EXTON PA
19341-1154
US

IV. Provider business mailing address

690 STOCKTON DR SUITE 100
EXTON PA
19341-1154
US

V. Phone/Fax

Practice location:
  • Phone: 601-458-3703
  • Fax:
Mailing address:
  • Phone: 601-458-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1013959840001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: HOLLY A. RASMUSSEN-JONES
Title or Position: SECRETARY
Credential:
Phone: 479-201-4835