Healthcare Provider Details

I. General information

NPI: 1043023484
Provider Name (Legal Business Name): DDS PREFERRED HOME CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 09/02/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 S PROGRESS AVE STE 2
HARRISBURG PA
17109-4600
US

IV. Provider business mailing address

55 S PROGRESS AVE STE 2
HARRISBURG PA
17109-4600
US

V. Phone/Fax

Practice location:
  • Phone: 223-207-3417
  • Fax:
Mailing address:
  • Phone: 223-207-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DORETHA SHANTE DONALD
Title or Position: CEO
Credential:
Phone: 717-614-7812