Healthcare Provider Details

I. General information

NPI: 1053074864
Provider Name (Legal Business Name): NATIONAL HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N BROAD ST
PHILA PA
19141-2107
US

IV. Provider business mailing address

4801 N BROAD ST
PHILA PA
19141-2107
US

V. Phone/Fax

Practice location:
  • Phone: 267-982-0007
  • Fax:
Mailing address:
  • Phone: 267-982-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: CHANTELLE JOHNSON
Title or Position: OWNER
Credential:
Phone: 267-982-0007