Healthcare Provider Details

I. General information

NPI: 1639176522
Provider Name (Legal Business Name): VISITING NURSE GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W GIRARD AVE
PHILADELPHIA PA
19123-1622
US

IV. Provider business mailing address

128 W GIRARD AVE
PHILADELPHIA PA
19123-1622
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-8888
  • Fax: 215-829-8875
Mailing address:
  • Phone: 215-829-8888
  • Fax: 215-829-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number764605
License Number StatePA

VIII. Authorized Official

Name: MR. CARMELO PENA GUADITE
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 215-829-8888