Healthcare Provider Details

I. General information

NPI: 1780401307
Provider Name (Legal Business Name): LEAD RESOURCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4442 RIDGE AVE
PHILADELPHIA PA
19129-1856
US

IV. Provider business mailing address

45 E CITY AVE UNIT 643
BALA CYNWYD PA
19004-2421
US

V. Phone/Fax

Practice location:
  • Phone: 215-485-1609
  • Fax:
Mailing address:
  • Phone: 215-485-1609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: SUMAIYAH MOSS
Title or Position: CEO
Credential:
Phone: 215-485-1609