Healthcare Provider Details

I. General information

NPI: 1699963736
Provider Name (Legal Business Name): FIRST HOME CARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 02/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 49TH ST 1ST FLOOR
PHILADELPHIA PA
19139-2718
US

IV. Provider business mailing address

7170 LAFAYETTE AVE
FORT WASHINGTON PA
19034-2301
US

V. Phone/Fax

Practice location:
  • Phone: 215-472-7291
  • Fax: 215-472-7296
Mailing address:
  • Phone: 215-641-5300
  • Fax: 615-653-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number122010
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number122010
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number122010
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number122010
License Number StatePA

VIII. Authorized Official

Name: MR. TROY BAILEY
Title or Position: CEO
Credential:
Phone: 757-966-1864