Healthcare Provider Details

I. General information

NPI: 1174841050
Provider Name (Legal Business Name): RELIABLE CAREGIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BRIGHTON ST
PHILADELPHIA PA
19149-1922
US

IV. Provider business mailing address

2924 BRIGHTON ST
PHILADELPHIA PA
19149-1922
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-1321
  • Fax: 215-624-1034
Mailing address:
  • Phone: 215-624-1321
  • Fax: 215-624-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number16713601
License Number StatePA

VIII. Authorized Official

Name: MR. CLARENCE A STUPPARD SR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-624-1321