Healthcare Provider Details

I. General information

NPI: 1699046821
Provider Name (Legal Business Name): CISCO HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 BEVERLY BLVD
UPPER DARBY PA
19082-3714
US

IV. Provider business mailing address

435 BEVERLY BLVD
UPPER DARBY PA
19082-3714
US

V. Phone/Fax

Practice location:
  • Phone: 267-385-1512
  • Fax:
Mailing address:
  • Phone: 267-385-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ARTHURLINE TUCKER CISCO
Title or Position: DIRECTOR
Credential:
Phone: 267-385-1512