Healthcare Provider Details

I. General information

NPI: 1952544900
Provider Name (Legal Business Name): WILKES BARRE HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 01/05/2017
Certification Date:
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

9510 ORMSBY STATION RD STE 300
LOUISVILLE KY
40223-4081
US

V. Phone/Fax

Practice location:
  • Phone: 570-718-4400
  • Fax: 570-718-4823
Mailing address:
  • Phone: 502-891-1187
  • Fax: 502-891-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICK TODD LYLES
Title or Position: SR VICE PRESIDENT
Credential:
Phone: 502-891-1104