Healthcare Provider Details

I. General information

NPI: 1902311590
Provider Name (Legal Business Name): PROSPECT CROZER HOME HEALTH AND HOSPICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W SPROUL RD
SPRINGFIELD PA
19064-2033
US

IV. Provider business mailing address

100 W SPROUL RD STE 223
SPRINGFIELD PA
19064-2033
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-8700
  • Fax:
Mailing address:
  • Phone: 610-284-0700
  • Fax: 610-284-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT J. ELDERS
Title or Position: ASSISTANT SECRETARY
Credential: ESQ.
Phone: 714-788-1249