Healthcare Provider Details

I. General information

NPI: 1285258335
Provider Name (Legal Business Name): J30 HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/14/2020
Certification Date: 07/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 MACDONALD AVE
WYNCOTE PA
19095-2402
US

IV. Provider business mailing address

272 MACDONALD AVE
WYNCOTE PA
19095-2402
US

V. Phone/Fax

Practice location:
  • Phone: 267-767-0662
  • Fax:
Mailing address:
  • Phone: 267-767-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAMAL-KALEE FERGUSON SR.
Title or Position: CEO
Credential: LBS
Phone: 267-767-0662