Healthcare Provider Details

I. General information

NPI: 1790274777
Provider Name (Legal Business Name): SYDMOND HEALTH SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2018
Last Update Date: 05/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 DIXON LN
RYDAL PA
19046-2431
US

IV. Provider business mailing address

1094 DIXON LN
RYDAL PA
19046-2431
US

V. Phone/Fax

Practice location:
  • Phone: 267-934-7165
  • Fax:
Mailing address:
  • Phone: 267-934-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier36483601
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CELESTINA O MBAH
Title or Position: CHIEF EXECUTIVE OFFICER/ADMINISTRAT
Credential:
Phone: 267-934-7165