Healthcare Provider Details

I. General information

NPI: 1710129762
Provider Name (Legal Business Name): WILKES BARRE HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RUTTER AVENUE SUITE 8
FORTY FORT PA
18704-4962
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 570-718-4400
  • Fax: 570-718-4823
Mailing address:
  • Phone: 337-223-1307
  • Fax: 337-443-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSHUA L. PROFFITT
Title or Position: TREASURER
Credential:
Phone: 337-223-1307