Healthcare Provider Details

I. General information

NPI: 1679993273
Provider Name (Legal Business Name): IMMACULATE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PENNSYLVANIA AVE
ORELAND PA
19075-1418
US

IV. Provider business mailing address

1300 PENNSYLVANIA AVE
ORELAND PA
19075-1418
US

V. Phone/Fax

Practice location:
  • Phone: 215-252-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DEMETRIUS ELLIS WARE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 215-252-6160