Healthcare Provider Details

I. General information

NPI: 1902891195
Provider Name (Legal Business Name): HOME HEALTH AGENCY -PHILADELPHIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 AIRPORT RD BELTWAY COMMONS, SUITE 138
HAZLE TOWNSHIP PA
18202-3361
US

IV. Provider business mailing address

510 HOSPITAL DR SUITE 100
MADISON TN
37115-5033
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-4050
  • Fax: 570-450-4051
Mailing address:
  • Phone: 615-712-2250
  • Fax: 615-577-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number80300501
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JORGE RICO
Title or Position: MANAGER
Credential:
Phone: 305-476-5160