Healthcare Provider Details

I. General information

NPI: 1093463150
Provider Name (Legal Business Name): AUTHENTIC HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 IDAHO AVE
NATRONA HEIGHTS PA
15065-1343
US

IV. Provider business mailing address

1005 IDAHO AVE
NATRONA HEIGHTS PA
15065-1343
US

V. Phone/Fax

Practice location:
  • Phone: 412-307-4564
  • Fax: 412-332-8023
Mailing address:
  • Phone: 412-307-4564
  • Fax: 412-332-8023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LYDIA MARIE REED
Title or Position: CEO
Credential: RN
Phone: 724-472-7617