Healthcare Provider Details

I. General information

NPI: 1336718147
Provider Name (Legal Business Name): CIVIL HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7943 FAYETTE ST
PHILADELPHIA PA
19150-2103
US

IV. Provider business mailing address

7943 FAYETTE ST
PHILADELPHIA PA
19150-2103
US

V. Phone/Fax

Practice location:
  • Phone: 215-820-8496
  • Fax:
Mailing address:
  • Phone: 215-820-8496
  • 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: KIMBERLY O'NEILL
Title or Position: PRESIDENT
Credential:
Phone: 215-820-8496