Healthcare Provider Details

I. General information

NPI: 1255334470
Provider Name (Legal Business Name): ASSIST HOME CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 W INDEPENDENCE ST
SHAMOKIN PA
17872-5313
US

IV. Provider business mailing address

27 W INDEPENDENCE ST
SHAMOKIN PA
17872-5313
US

V. Phone/Fax

Practice location:
  • Phone: 570-644-9840
  • Fax: 570-644-9841
Mailing address:
  • Phone: 570-644-9840
  • Fax: 570-644-9841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number3000007788
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1012296060001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. CHARLES RICHARD PRENTISS
Title or Position: PRESIDENT
Credential:
Phone: 570-644-9840