Healthcare Provider Details

I. General information

NPI: 1982980256
Provider Name (Legal Business Name): A LONG TERM COMPANION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 IRON HORSE ROAD
HUNTINGDON VALLEY PA
19006-7751
US

IV. Provider business mailing address

1715 IRON HORSE ROAD
HUNTINGDON VALLEY PA
19006-7751
US

V. Phone/Fax

Practice location:
  • Phone: 215-914-1800
  • Fax: 215-947-7727
Mailing address:
  • Phone: 215-914-1800
  • Fax: 215-947-7727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number20233601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number26NR10140300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT0010122L
License Number StatePA

VIII. Authorized Official

Name: MRS. MICHELE KILSTEIN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 215-914-1800