Healthcare Provider Details

I. General information

NPI: 1144604281
Provider Name (Legal Business Name): MAIN LINE HEALTH HOMECARE AND HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N RADNOR CHESTER RD SUITE 100
RADNOR PA
19087-5170
US

IV. Provider business mailing address

240 N RADNOR CHESTER RD SUITE 100
RADNOR PA
19087-5170
US

V. Phone/Fax

Practice location:
  • Phone: 484-580-1400
  • Fax: 484-580-1414
Mailing address:
  • Phone: 484-580-1400
  • Fax: 484-580-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number39-7012A
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007537580006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: TERRE L. MIRSCH
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, BSN, CHPCA, CHP
Phone: 484-580-1400