Healthcare Provider Details

I. General information

NPI: 1609472356
Provider Name (Legal Business Name): ADVANCE HOME HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 BROADWAY AVE
SECANE PA
19018-2029
US

IV. Provider business mailing address

1117 BROADWAY AVE
SECANE PA
19018-2029
US

V. Phone/Fax

Practice location:
  • Phone: 484-461-3950
  • Fax: 484-461-3950
Mailing address:
  • Phone: 484-461-3950
  • Fax: 484-461-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED L SESAY
Title or Position: PRESIDENT
Credential: RN
Phone: 484-461-3950