Healthcare Provider Details

I. General information

NPI: 1184351363
Provider Name (Legal Business Name): CYNDRAANITA WILSON HOMECARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2022
Last Update Date: 08/06/2022
Certification Date: 08/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S 15TH ST
PHILADELPHIA PA
19146-3141
US

IV. Provider business mailing address

1140 S 15TH ST
PHILADELPHIA PA
19146-3141
US

V. Phone/Fax

Practice location:
  • Phone: 215-545-2273
  • Fax:
Mailing address:
  • Phone: 215-545-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNDRAANITA WILSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-237-6439