Healthcare Provider Details

I. General information

NPI: 1114880259
Provider Name (Legal Business Name): GILS LEGACY HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 STENTON AVE APT 17J
PHILADELPHIA PA
19118-3256
US

IV. Provider business mailing address

7600 STENTON AVE APT 17J
PHILADELPHIA PA
19118-3256
US

V. Phone/Fax

Practice location:
  • Phone: 215-390-6385
  • Fax:
Mailing address:
  • Phone: 215-390-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SHANIKA MCCLOUD
Title or Position: OWNER / ADMINISTRATOR
Credential:
Phone: 215-390-6385