Healthcare Provider Details

I. General information

NPI: 1205523636
Provider Name (Legal Business Name): MASKQUI HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 BUNTING PL
PHILADELPHIA PA
19153-2325
US

IV. Provider business mailing address

7307 BUNTING PL
PHILADELPHIA PA
19153-2325
US

V. Phone/Fax

Practice location:
  • Phone: 267-269-9509
  • Fax:
Mailing address:
  • Phone: 267-269-9509
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TARLEY QUIYEA
Title or Position: CEO
Credential:
Phone: 267-269-9509