Healthcare Provider Details

I. General information

NPI: 1790698967
Provider Name (Legal Business Name): SUPACARE COMMUNITY LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 E TIOGA ST # 1
PHILADELPHIA PA
19134-2634
US

IV. Provider business mailing address

1201 N 3RD ST # 119
PHILADELPHIA PA
19122-4425
US

V. Phone/Fax

Practice location:
  • Phone: 267-901-7482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TYLER HUNT
Title or Position: OWNER
Credential:
Phone: 267-901-7482