Healthcare Provider Details

I. General information

NPI: 1982095568
Provider Name (Legal Business Name): IMMEDIATE HOMECARE & HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 MARKET ST STE 4B
PHILADELPHIA PA
19104-3133
US

IV. Provider business mailing address

3901 MARKET ST STE 4B
PHILADELPHIA PA
19104-3133
US

V. Phone/Fax

Practice location:
  • Phone: 215-638-2223
  • Fax:
Mailing address:
  • Phone: 215-638-2223
  • Fax: 215-638-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number765005
License Number StatePA

VIII. Authorized Official

Name: MARI WILLIS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 216-970-1189