Healthcare Provider Details

I. General information

NPI: 1417464447
Provider Name (Legal Business Name): LAGOM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 CASTOR AVE STE 2
PHILADELPHIA PA
19152-3624
US

IV. Provider business mailing address

7131 SAUL ST
PHILADELPHIA PA
19149-1216
US

V. Phone/Fax

Practice location:
  • Phone: 215-516-6826
  • Fax: 215-302-2050
Mailing address:
  • Phone: 215-987-9917
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: VASTI J MIRANDA CARTAGENA
Title or Position: CEO
Credential:
Phone: 215-516-6826