Healthcare Provider Details

I. General information

NPI: 1750301453
Provider Name (Legal Business Name): Project Home Health Services
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2144 Ceceil B. Moore Ave.
PHILADELPHIA PA
19121
US

IV. Provider business mailing address

2144 Cecil B. Moore Ave.
PHILADELPHIA PA
19121
US

V. Phone/Fax

Practice location:
  • Phone: 215-320-6187
  • Fax:
Mailing address:
  • Phone: 215-320-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD060038L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086H0002X
TaxonomyHospice and Palliative Medicine (Surgery) Physician
License NumberMD060038L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD060038L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD060038L
License Number StatePA
# 5
Primary Taxonomy
Taxonomy Code
TaxonomyAddiction Medicine
License NumberMD060038L
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: