Healthcare Provider Details

I. General information

NPI: 1831535293
Provider Name (Legal Business Name): EASTWICK FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MARKET STREET SUITE 204
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3801 MARKET STREET SUITE 204
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 267-709-5589
  • Fax:
Mailing address:
  • Phone: 267-709-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID M SUMO
Title or Position: EXECUTIVE DIRECTOR
Credential: BSC
Phone: 267-709-5589