Healthcare Provider Details

I. General information

NPI: 1679269088
Provider Name (Legal Business Name): MISS KALIA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N 5TH ST LOWR LEVEL
READING PA
19601-3417
US

IV. Provider business mailing address

3603 OLIVE ST
PHILADELPHIA PA
19104-1676
US

V. Phone/Fax

Practice location:
  • Phone: 267-591-9755
  • Fax:
Mailing address:
  • Phone: 610-202-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN769292
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberRN769292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: