Healthcare Provider Details

I. General information

NPI: 1043806763
Provider Name (Legal Business Name): SCUTT HOME CARE AGENCY L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 MCKINLEY ST
PHILADELPHIA PA
19149-3536
US

IV. Provider business mailing address

2123 MCKINLEY ST
PHILADELPHIA PA
19149-3536
US

V. Phone/Fax

Practice location:
  • Phone: 267-748-9706
  • Fax:
Mailing address:
  • Phone: 267-748-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: WIDLYNNE PIERRE-SCUTT
Title or Position: OWNER
Credential:
Phone: 267-748-9706