Healthcare Provider Details

I. General information

NPI: 1790767622
Provider Name (Legal Business Name): SUCCESSFUL AGING CARE NET INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 GARRETT RD
UPPER DARBY PA
19082-2303
US

IV. Provider business mailing address

48 GARRETT RD
UPPER DARBY PA
19082-2303
US

V. Phone/Fax

Practice location:
  • Phone: 484-461-8711
  • Fax: 610-284-4170
Mailing address:
  • Phone: 484-461-8711
  • Fax: 610-284-4170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number80200501
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5418770001
License Number StatePA

VIII. Authorized Official

Name: MR. INNOCENT ONWUBIKO
Title or Position: OWNER
Credential: MSHA, MSGS
Phone: 484-461-8711