Healthcare Provider Details

I. General information

NPI: 1417455734
Provider Name (Legal Business Name): JEVS CARE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6315 FORBES AVE STE B025
PITTSBURGH PA
15217-1731
US

IV. Provider business mailing address

9350 ASHTON RD RM 102
PHILADELPHIA PA
19114-7401
US

V. Phone/Fax

Practice location:
  • Phone: 412-742-4033
  • Fax:
Mailing address:
  • Phone: 267-298-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number29713601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number29713601
License Number StatePA

VIII. Authorized Official

Name: ROBERT JAMISON
Title or Position: VP ORGANIZATIONAL DEVELOPMENT
Credential:
Phone: 267-298-1619