Healthcare Provider Details

I. General information

NPI: 1962837443
Provider Name (Legal Business Name): BAYADA HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOOVER ST
OLD FORGE PA
18518-2218
US

IV. Provider business mailing address

112 HOOVER ST
OLD FORGE PA
18518-2218
US

V. Phone/Fax

Practice location:
  • Phone: 570-241-8187
  • Fax:
Mailing address:
  • Phone: 570-241-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSL010460
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MEGAN ANN SALLAVANTI
Title or Position: SPEECH THERAPIST
Credential: MS CCC SLP
Phone: 570-241-8187