Healthcare Provider Details

I. General information

NPI: 1952770638
Provider Name (Legal Business Name): DEBORAH BABAWALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6343 RISING SUN AVE FIRST FLOOR
PHILADELPHIA PA
19111-5629
US

IV. Provider business mailing address

6343 RISING SUN AVE FIRST FLOOR
PHILADELPHIA PA
19111-5629
US

V. Phone/Fax

Practice location:
  • Phone: 215-268-2354
  • Fax:
Mailing address:
  • Phone: 215-268-2354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN663146
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: