Healthcare Provider Details

I. General information

NPI: 1144228677
Provider Name (Legal Business Name): MCNELIS HOME CARE COMPANY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 S CHURCH ST
HAZLETON PA
18201-7684
US

IV. Provider business mailing address

785 S CHURCH ST
HAZLETON PA
18201-7684
US

V. Phone/Fax

Practice location:
  • Phone: 570-459-0202
  • Fax: 570-459-0607
Mailing address:
  • Phone: 570-459-0202
  • Fax: 570-459-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN F MCNELIS
Title or Position: CEO/PRESIDENT
Credential:
Phone: 570-459-0202