Healthcare Provider Details

I. General information

NPI: 1295130474
Provider Name (Legal Business Name): LARIE HOME CARE SERVICES & STAFFING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 ACADEMY RD 210
PHILADELPHIA PA
19154-1932
US

IV. Provider business mailing address

12401 ACADEMY RD 210
PHILADELPHIA PA
19154-1932
US

V. Phone/Fax

Practice location:
  • Phone: 888-851-5967
  • Fax: 267-538-6529
Mailing address:
  • Phone: 888-851-5967
  • Fax: 267-538-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number26203601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number26203601
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number26203601
License Number StatePA

VIII. Authorized Official

Name: MS. LAURA KALU
Title or Position: SENIOR ADVISOR
Credential: BSN, RN
Phone: 888-851-5967