Healthcare Provider Details

I. General information

NPI: 1730185208
Provider Name (Legal Business Name): PATIENT CARE PENNSYLVANIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MERIDIAN BLVD STE 214
WYOMISSING PA
19610-3202
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 610-373-0300
  • Fax: 610-373-3209
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number757805
License Number StatePA

VIII. Authorized Official

Name: MR. NICHOLAS GACHASSIN III
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 337-233-1307