Healthcare Provider Details

I. General information

NPI: 1083579411
Provider Name (Legal Business Name): 540 HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 RISING SUN AVE
PHILADELPHIA PA
19140-3353
US

IV. Provider business mailing address

540 RISING SUN AVE
PHILADELPHIA PA
19140-3353
US

V. Phone/Fax

Practice location:
  • Phone: 215-688-2495
  • Fax:
Mailing address:
  • Phone: 215-688-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSE CRUZ
Title or Position: PRESIDENT
Credential:
Phone: 215-688-2495