Healthcare Provider Details

I. General information

NPI: 1295074045
Provider Name (Legal Business Name): PREFERRED GERIATRIC HEALTH CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 S 56TH ST
PHILA PA
19139-3903
US

IV. Provider business mailing address

272 S 56TH ST
PHILADELPHIA PA
19139-3903
US

V. Phone/Fax

Practice location:
  • Phone: 215-551-5620
  • Fax: 215-474-4850
Mailing address:
  • Phone: 215-551-5620
  • Fax: 215-474-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number23573601
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number23573601
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number23573601
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number23573601
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number23573601
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number23573601
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number23573601
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number23573601
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number23573601
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number23573601
License Number StatePA
# 11
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number23573601
License Number StatePA
# 12
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number23573601
License Number StatePA
# 13
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number23573601
License Number StatePA
# 14
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number23573601
License Number StatePA
# 15
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number23573601
License Number StatePA

VIII. Authorized Official

Name: MS. MICHELLE ORISHA BOURNE
Title or Position: CEO
Credential:
Phone: 215-551-5620