Healthcare Provider Details

I. General information

NPI: 1205133402
Provider Name (Legal Business Name): WHOLE SENIOR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 05/17/2022
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 HENRY LN
WALLINGFORD PA
19086-6412
US

IV. Provider business mailing address

306 HENRY LN
WALLINGFORD PA
19086-6412
US

V. Phone/Fax

Practice location:
  • Phone: 267-997-8866
  • Fax:
Mailing address:
  • Phone: 267-997-8866
  • Fax: 833-315-2198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCW016886
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAYMA C SITTON
Title or Position: PROPRIETOR
Credential: LCSW
Phone: 267-997-8866