Healthcare Provider Details

I. General information

NPI: 1609449172
Provider Name (Legal Business Name): HOME AWAY FROM HOME ADULT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N PROVIDENCE RD
MEDIA PA
19063-1204
US

IV. Provider business mailing address

1211 N PROVIDENCE RD
MEDIA PA
19063-1204
US

V. Phone/Fax

Practice location:
  • Phone: 484-442-8370
  • Fax: 610-200-1234
Mailing address:
  • Phone: 484-442-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANE FERRY
Title or Position: OWNER
Credential:
Phone: 484-442-8370