Healthcare Provider Details

I. General information

NPI: 1134777220
Provider Name (Legal Business Name): CHARLES FINNY GRAHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2019
Last Update Date: 08/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WALNUT ST STE 800
PHILADELPHIA PA
19102-3505
US

IV. Provider business mailing address

1500 WALNUT ST STE 800
PHILADELPHIA PA
19102-3505
US

V. Phone/Fax

Practice location:
  • Phone: 215-594-9875
  • Fax: 215-515-3925
Mailing address:
  • Phone: 215-594-9875
  • Fax: 215-515-3925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: