Healthcare Provider Details

I. General information

NPI: 1750611323
Provider Name (Legal Business Name): CREDENCE HOME CARE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 N BROAD ST STE 118
PHILADELPHIA PA
19122-3324
US

IV. Provider business mailing address

1415 N BROAD ST STE 118
PHILADELPHIA PA
19122-3324
US

V. Phone/Fax

Practice location:
  • Phone: 215-764-5529
  • Fax: 215-825-8406
Mailing address:
  • Phone: 215-764-5529
  • Fax: 215-825-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number315964
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number31213601
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number31213601
License Number StatePA

VIII. Authorized Official

Name: DR. CAJETAN ONUOHA
Title or Position: ADMINISTRATOR
Credential:
Phone: 215-764-5529