Healthcare Provider Details

I. General information

NPI: 1053959494
Provider Name (Legal Business Name): ALYOSHA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 ANDOVER RD
UPPER DARBY PA
19082-5203
US

IV. Provider business mailing address

PO BOX 2308
UPPER DARBY PA
19082-0808
US

V. Phone/Fax

Practice location:
  • Phone: 610-609-9460
  • Fax:
Mailing address:
  • Phone: 610-609-9460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: EBONY JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 610-609-9460