Healthcare Provider Details

I. General information

NPI: 1417812850
Provider Name (Legal Business Name): HOME SIDE COMPANION CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 W RUSCOMB ST
PHILADELPHIA PA
19141-3909
US

IV. Provider business mailing address

1029 W RUSCOMB ST
PHILADELPHIA PA
19141-3909
US

V. Phone/Fax

Practice location:
  • Phone: 267-515-2644
  • Fax:
Mailing address:
  • Phone: 267-515-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. ANIKA KENNEDY
Title or Position: CEO
Credential:
Phone: 267-796-0056