Healthcare Provider Details

I. General information

NPI: 1366673790
Provider Name (Legal Business Name): DEER MEADOWS HOME HEALTH AND SUPPORT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 08/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

IV. Provider business mailing address

8301 ROOSEVELT BLVD
PHILADELPHIA PA
19152-2006
US

V. Phone/Fax

Practice location:
  • Phone: 215-624-6038
  • Fax: 215-624-6258
Mailing address:
  • Phone: 215-624-6038
  • Fax: 215-624-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StatePA

VIII. Authorized Official

Name: MS. LISA SOFIA
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: RN, BSN, AHM, NHA
Phone: 215-624-3333