Healthcare Provider Details

I. General information

NPI: 1699491563
Provider Name (Legal Business Name): KINGSWAY HOMECARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/20/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 OLD CEDARBROOK RD
WYNCOTE PA
19095-2043
US

IV. Provider business mailing address

PO BOX 1173
GLENSIDE PA
19038-6173
US

V. Phone/Fax

Practice location:
  • Phone: 215-802-6777
  • Fax:
Mailing address:
  • Phone: 215-885-1816
  • 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 Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: ANGELA M KING
Title or Position: DIRECTOR
Credential:
Phone: 215-885-1816