Healthcare Provider Details

I. General information

NPI: 1417796285
Provider Name (Legal Business Name): ENOCH HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 ROOSEVELT BLVD APT B301
PHILADELPHIA PA
19152-4332
US

IV. Provider business mailing address

7400 ROOSEVELT BLVD APT B301
PHILADELPHIA PA
19152-4332
US

V. Phone/Fax

Practice location:
  • Phone: 445-266-8037
  • Fax:
Mailing address:
  • Phone: 445-266-8037
  • 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: ADEGBUYI OSINLOYE
Title or Position: PRESIDENT
Credential:
Phone: 445-266-8037