Healthcare Provider Details

I. General information

NPI: 1861045080
Provider Name (Legal Business Name): SWEET HOME PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 E ALLEGHENY AVE STE 303
PHILADELPHIA PA
19134-2338
US

IV. Provider business mailing address

426 E ALLEGHENY AVE STE 303
PHILADELPHIA PA
19134-2338
US

V. Phone/Fax

Practice location:
  • Phone: 215-739-1400
  • 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 State

VIII. Authorized Official

Name: JED RYAN
Title or Position: CFO
Credential:
Phone: 215-852-0242