Healthcare Provider Details

I. General information

NPI: 1992700074
Provider Name (Legal Business Name): HOME CARE HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 GRANT AVE
PHILADELPHIA PA
19114-1007
US

IV. Provider business mailing address

2801 GRANT AVE
PHILADELPHIA PA
19114-1007
US

V. Phone/Fax

Practice location:
  • Phone: 215-552-9980
  • Fax: 215-552-9981
Mailing address:
  • Phone: 215-552-9980
  • Fax: 215-552-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number391635
License Number StatePA

VIII. Authorized Official

Name: ALEX PUGMAN
Title or Position: HOSPICE DIRECTOR
Credential: RN
Phone: 215-552-9980