Healthcare Provider Details

I. General information

NPI: 1720493992
Provider Name (Legal Business Name): PRUDENTIACARE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 MARKET ST STE 3750
PHILADELPHIA PA
19103-7532
US

IV. Provider business mailing address

1735 MARKET STREET, STE 3750
PHILADELPHIA PA
19103
US

V. Phone/Fax

Practice location:
  • Phone: 267-507-6030
  • Fax: 267-504-6150
Mailing address:
  • Phone: 267-507-6030
  • Fax: 267-504-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAVON MARIE PATTERSON
Title or Position: OWNER
Credential:
Phone: 267-634-1479