Healthcare Provider Details

I. General information

NPI: 1346616109
Provider Name (Legal Business Name): OPEN HANDS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 WOODWARD ST APT F5
PHILADELPHIA PA
19115-5144
US

IV. Provider business mailing address

2333 REAR EDGLEY ST
PHILADELPHIA PA
19121-3530
US

V. Phone/Fax

Practice location:
  • Phone: 267-977-2828
  • Fax:
Mailing address:
  • Phone: 267-977-2828
  • 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

VIII. Authorized Official

Name: SHELLY TERRY E MCNEAR
Title or Position: CEO/PRESIDENT
Credential:
Phone: 267-977-2828