Healthcare Provider Details

I. General information

NPI: 1861182610
Provider Name (Legal Business Name): UNITED HOMECARE SUPPORT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 GREENE ST APT 314
PHILADELPHIA PA
19144-2528
US

IV. Provider business mailing address

6350 GREENE ST APT 314
PHILADELPHIA PA
19144-2528
US

V. Phone/Fax

Practice location:
  • Phone: 443-635-1657
  • Fax:
Mailing address:
  • Phone: 443-635-1657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name: BUSAYO DICKSON AJAYI
Title or Position: CEO
Credential:
Phone: 443-635-1657