Healthcare Provider Details

I. General information

NPI: 1386712677
Provider Name (Legal Business Name): MAHOGANY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 GEIGER RD SUITE F
PHILADELPHIA PA
19115-1016
US

IV. Provider business mailing address

270 GEIGER RD SUITE F
PHILADELPHIA PA
19115-1016
US

V. Phone/Fax

Practice location:
  • Phone: 215-237-4503
  • Fax: 215-464-7308
Mailing address:
  • Phone: 215-237-4503
  • Fax: 215-464-7308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DWAYNE DAVID ROYSTER
Title or Position: PRESIDENT
Credential:
Phone: 215-237-4503