Healthcare Provider Details

I. General information

NPI: 1093136202
Provider Name (Legal Business Name): TANYA'S HOME HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 WATKINS ST
PHILADELPHIA PA
19145-1828
US

IV. Provider business mailing address

2331 WATKINS ST
PHILADELPHIA PA
19145
US

V. Phone/Fax

Practice location:
  • Phone: 215-397-0227
  • Fax:
Mailing address:
  • Phone: 215-397-0227
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE BUSSEY
Title or Position: CERTIFIED NURSING ASSISTANT
Credential:
Phone: 215-397-0227